Billing code 55705: Prostate biopsyMedicare rate & RVUs in Ohio
Reports needle sampling of prostate tissue by any approach when imaging guidance is not used, commonly to evaluate suspected prostate cancer.
Medicare pays $219.05 for 55705 in the office in Ohio (Ohio). 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 55705 covers
A urologist typically performs this needle biopsy to obtain prostate tissue for pathologic evaluation, often after an elevated prostate-specific antigen result or an abnormal prostate examination raises concern for cancer. The approach may be transrectal or transperineal; the defining feature is that imaging is not used to guide the sampling. The service may occur in a procedure room or operating-room setting, with tissue sent for separate pathologic examination.
Report 55705 for the non-imaging-guided biopsy itself, rather than a code that specifies ultrasound, MRI fusion, or other imaging guidance. The record should support the indication, approach, and performance of tissue sampling without imaging guidance. The 0-day global period includes same-day preoperative and postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery; co-surgeon payment requires supporting documentation, and team surgery is 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.
55705 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | $219.05 | $97.37 |
How the 55705 rate is calculated
Each of 55705’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 · 55705
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.88Practice expense 4.87Malpractice 0.23
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 55705
The CMS indicators that decide how 55705 is paid alongside other services.
CMS payment indicators · 55705
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) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| 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
55705 without 51 · national office
$233.14
Prostate biopsy
55705-51 · Second procedure: 50%
$116.57
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%).
55705 compared with similar codes
Compare codes
55705 vs 55706 vs 55707 vs 55709 vs 55711: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 55706Prostate biopsy
- 55706 is for saturation sampling. 55705 is the non-imaging biopsy code when the documented sampling is not described as saturation sampling.
- 55707Prostate biopsy
- 55707 specifies transrectal ultrasound guidance. Use 55705 when imaging does not guide the prostate biopsy.
- 55709Prostate biopsy
- 55709 specifies transperineal ultrasound guidance. 55705 describes biopsy without imaging guidance, regardless of approach.
- 55711Prostate biopsy
- 55711 describes transrectal biopsy with MRI-ultrasound fusion guidance; 55705 is for biopsy without imaging guidance.
55705 billing questions
When should 55705 be chosen over an image-guided prostate biopsy code?
Choose 55705 when prostate tissue is sampled without imaging guidance. If ultrasound, MRI fusion, or another specified imaging method guides the biopsy, select the code that describes that method.
How does 55705 differ from 55706?
55705 describes prostate needle biopsy without imaging guidance. 55706 is for saturation sampling, a distinct sampling approach; use it when the documented service meets that description.
Can pathology be billed separately?
The biopsy service obtains the tissue; pathologic examination is a separate service when performed and reported by the pathology provider.
Should modifier 50 be used for sampling both sides of the prostate?
No. CMS bilateral adjustment does not apply to 55705, and modifier 50 is inappropriate.
How does Medicare handle 55705 with another procedure in the same session?
The highest-valued procedure is paid in full, and other procedures in the same session are subject to the standard multiple-procedure reduction.
What same-day care is included in the global period?
The 0-day global period includes same-day preoperative and postoperative care.
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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