Billing code 55707: Prostate biopsyMedicare rate & RVUs in Nebraska
Reports needle sampling of prostate tissue through the rectum with ultrasound guidance, commonly during evaluation of an elevated PSA or abnormal examination.
Medicare pays $316.08 for 55707 in the office in Nebraska (Nebraska). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 55707 covers
A urologist typically uses a transrectal ultrasound probe to visualize the prostate and guide a needle that collects tissue cores. The procedure is commonly performed in an office or outpatient setting when prostate cancer is suspected, such as after an elevated prostate-specific antigen result or an abnormal digital rectal examination. The ultrasound-guided transrectal approach distinguishes this service from biopsies performed without imaging, by another route, or with MRI fusion.
Select the code when the documented biopsy uses the transrectal route and ultrasound guidance; the procedure note should support the approach and imaging method. The 0-day global period includes same-day preoperative and postoperative care. If other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
55707 in Nebraska
| Payment locality | Office | Facility |
|---|---|---|
| Nebraska | $316.08 | $126.18 |
How the 55707 rate is calculated
Each of 55707’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 55707
RVUs × geographic indexes × conversion factor
Work2.63
2.63 RVUs× 1.000 GPCI
Practice expense7.26
7.26 RVUs× 1.000 GPCI
Malpractice0.35
0.35 RVUs× 1.000 GPCI
Adjusted RVUs
10.2400
Conversion factor
$33.4009
Medicare rate
$342.03
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 55707
The CMS indicators that decide how 55707 is paid alongside other services.
CMS payment indicators · 55707
Prostate biopsy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
55707 without 51 · national office
$342.03
Prostate biopsy
55707-51 · Second procedure: 50%
$171.02
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
55707 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 55705Prostate biopsy
- Use 55707 when ultrasound guides a transrectal biopsy. Use 55705 when the biopsy is performed without imaging guidance.
- 55706Prostate biopsy
- 55706 identifies transrectal saturation sampling. 55707 is selected for a transrectal biopsy guided by ultrasound when saturation sampling is not the defining method.
- 55708Prostate biopsy
- 55708 is the transrectal ultrasound-guided option with MRI fusion. Report 55707 for ultrasound-guided transrectal sampling without MRI fusion.
- 55709Prostate biopsy
- Both involve ultrasound guidance, but 55709 uses the transperineal route; 55707 uses the transrectal route.
55707 billing questions
How does this differ from 55705?
55707 describes a transrectal biopsy performed with ultrasound guidance. Use 55705 when the biopsy is performed without imaging guidance.
When is 55706 a better fit?
55706 identifies transrectal needle sampling using a saturation technique. Choose based on the documented sampling method, rather than treating it as a routine ultrasound-guided biopsy.
Does MRI fusion change the code choice?
Yes. Code 55708 is the related transrectal ultrasound-guided biopsy option with MRI fusion; 55707 describes ultrasound guidance without that fusion distinction.
Can modifier 50 be reported for biopsies of both sides?
No. Modifier 50 is inappropriate for this code. The CMS bilateral adjustment does not apply.
What same-day care is included in the global period?
The 0-day global period includes same-day preoperative and postoperative care. Procedures performed in the same session are subject to the standard multiple-procedure payment reduction.
When can an assistant at surgery be paid?
Assistant-at-surgery payment is allowed only when the record documents medical necessity. Co-surgeons and team surgery are not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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