CPT 55700 is a needle biopsy of the prostate, usually guided by ultrasound through the rectum (or through the skin of the perineum), taking twelve or more tissue samples to check for cancer after an elevated PSA or an abnormal exam. It takes 15 to 20 minutes, typically with local anesthesia.
What the price covers
The hospital's price is the facility fee for the procedure room, ultrasound and supplies. The urologist, the ultrasound guidance (76872) and the pathology for each sample are billed separately. Pathology on twelve cores can cost more than the biopsy itself, so ask how it is billed. An MRI-fusion biopsy uses additional codes.
Why prices vary
Many urologists perform prostate biopsies in their own office, where the total is often far below a hospital's facility fee. Hospital prices within a metro area vary several times.
Questions to ask
- What is the self-pay price for 55700, plus ultrasound guidance and pathology?
- Is pathology billed per core or as one charge?
- Can the biopsy be done in the urologist's office?