Billing code 55715: Prostate biopsyMedicare rate & RVUs in Oregon
Reports sampling of each additional prostate lesion targeted with MRI-US fusion or CT/MR guidance during a guided prostate biopsy.
Medicare pays $79.61–$85.13 for 55715 in the office in Oregon, from Rest Of Oregon to Portland. 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 55715 covers
This add-on represents sampling an additional distinct prostate lesion after the primary lesion in a biopsy performed with MRI-US fusion or CT/MR guidance. A urologist typically uses MRI findings to identify targets and obtain tissue cores from them in an outpatient procedure room or hospital setting. The additional lesion may be sampled during the same session as systematic cores, but those cores alone do not establish an additional targeted lesion.
Report this code with the applicable primary procedure for the guided biopsy, such as the first-lesion codes 55711–55714. The record should identify the additional target and support that it was sampled; count distinct lesions, not the number of cores taken from one lesion. This is an add-on code, not a stand-alone service, and Medicare pays it within the primary procedure’s global period.
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.
Where 55715 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | $85.13 | $47.27 |
| Rest Of Oregon | $79.61 | $45.68 |
How the 55715 rate is calculated
Each of 55715’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 · 55715
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.05Practice expense 1.24Malpractice 0.14
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 55715
The CMS indicators that decide how 55715 is paid alongside other services.
CMS payment indicators · 55715
Prostate biopsy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| 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. |
55715 compared with similar codes
Compare codes
55715 vs 55711 vs 55712 vs 55713 vs 55706: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 55711Prostate biopsy
- 55711 represents the first lesion sampled with transrectal MRI-US guidance. Use 55715 for each additional distinct lesion sampled in the applicable guided-biopsy session.
- 55712Prostate biopsy
- 55712 represents the first lesion sampled with transperineal MRI-US guidance. This code is for additional distinct lesions, not the initial target.
- 55713Prostate biopsy
- 55713 represents the first lesion in an in-bore CT/MRI-guided biopsy. This code accounts for additional distinct lesion sampling.
- 55706Prostate biopsy
- 55706 describes transperineal template-guided saturation sampling. It is not the additional-lesion code for an MRI-US fusion or CT/MR-guided biopsy.
55715 billing questions
When is this code reported instead of a first-lesion code?
Use it for an additional distinct lesion sampled during an MRI-US fusion or CT/MR-guided prostate biopsy. The applicable primary code represents the first lesion.
Which primary procedure codes can it accompany?
Pair it with the applicable primary guided-biopsy code, including the first-lesion codes 55711–55714. It cannot be reported by itself.
Are additional cores from one target separately counted?
No. The unit is based on an additional distinct lesion sampled, not the number of cores obtained from that lesion.
What documentation supports an additional lesion?
Document the additional target, its identification through the guided-biopsy process, and that tissue was sampled from it.
How does Medicare treat payment for this add-on?
Medicare pays it only with a primary procedure and within that procedure’s global period.
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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