CPT Code 55700 in 2026: Why It Was Deleted and What Replaced It

QUICK ANSWER

• What is CPT code 55700? CPT code 55700 was the prostate needle biopsy code reported once per session regardless of the number of cores collected. The AMA deleted 55700 effective January 1, 2026, and replaced it with nine approach-specific codes, 55707 through 55715, that bundle imaging guidance into the procedure. Any 2026 claim submitted with 55700 will be denied automatically.
• What it covered: Prostate biopsy by any approach, transrectal, transperineal, or endoscopic, with imaging guidance such as ultrasound billed separately under its own code.
• Why it changed: The AMA CPT Editorial Panel voted in May 2024 to replace 55700 with technique-specific codes that reflect the shift toward transperineal and MRI-fusion biopsies across urology practices.
• What to use now: One of nine new codes, 55707 through 55715, chosen by approach and imaging guidance, plus revised code 55705 for non-image-guided biopsies.

What Was the CPT 55700 Code Description?

CPT 55700 described a prostate biopsy by needle or punch, single or multiple specimens, performed through any approach. It was reported once per session regardless of how many cores were taken, carried a zero-day global surgical period, and could be used in both office and facility settings. Imaging guidance was not part of the code’s value, so providers billed ultrasound guidance separately.

Because the code was written so broadly, it could not distinguish a traditional transrectal ultrasound-guided biopsy from an advanced MRI-fusion targeted biopsy. Both were reported the same way, which no longer matched how urology practices actually work. In its final year, the 2025 Medicare reimbursement for 55700 was approximately $240.67 in a non-facility setting, and imaging guidance was reimbursed on top of that when performed.

Providers often come to us after discovering that their biopsy reimbursement dropped without explanation, and the root cause is almost always a coding mismatch between the procedure performed and the code reported. Under the old 55700, that mismatch was invisible because one code covered everything. Under the 2026 structure, it shows up immediately as a denial. For a broader look at how urology procedure codes interact, see our urology CPT coding guide.

What CPT Code Replaced 55700?

No single code replaced 55700. The American Medical Association deleted it from the 2026 CPT code book and created nine new codes, 55707 through 55715, while revising 55705 for non-image-guided biopsies. Each new code specifies the approach, the imaging guidance, and whether the sampling was systematic, targeted to a lesion, or both. Imaging guidance is now bundled into every code, so ultrasound and MRI guidance are no longer billed separately.

Use the table below to match the procedure to the correct 2026 code.

CPT is a registered trademark of the American Medical Association. Confirm the full official descriptors in the 2026 CPT code book before billing.

How to Pick the Right 55700 Replacement Code in 2026

The right code now depends on three documented facts about the procedure. Work through them in order.

1. Document the biopsy approach: transrectal, transperineal, or in-bore.
2. Identify the imaging guidance used: none, ultrasound, MRI-ultrasound fusion, or in-bore CT or MRI.
3. Determine whether sampling was systematic, targeted to a lesion, or both.
4. Match those three facts to a single code from 55705 or 55707 through 55714.
5. Add +55715 for each additional targeted lesion beyond the first.
6. Stop reporting ultrasound guidance (76872) separately, since imaging is now bundled into the new codes.
7. Update the superbill and EMR templates so 55700 can no longer be selected on a 2026 claim.

One question we hear constantly from urology practice managers is whether their existing superbill still works. The answer for prostate biopsies is no. If 55700 is still on the template, every biopsy claim goes out with a deleted code and comes back denied. The fix is a one-time template update, but the cost of not doing it compounds with every procedure. Practices running testicular needle biopsy (54500) volumes alongside prostate biopsies should audit both code families at the same time to catch any template gaps in one pass.

The Billing Changes That Catch Urology Practices Off Guard

The code swap looks simple on paper, but the parts that quietly cost practices money are the ones that are easy to miss. Three changes matter most.

• Imaging is bundled now. Ultrasound guidance code 76872 and MRI guidance are folded into the new biopsy codes. Practices that keep billing them separately out of habit will see those line items denied and, in an audit, flagged as unbundling. The National Correct Coding Initiative (NCCI) edits for 2026 explicitly bundle these guidance codes with 55707 through 55715.
• Documentation drives the code. The urologist must clearly state the approach and the guidance method in the operative note. Without that detail, a coder cannot pick between 55707 and 55711, and the claim either stalls or goes out wrong. Under the old 55700, vague documentation still produced a payable claim. Under the new structure, vague documentation produces a denial.
• A deleted code is an automatic denial. Any 2026 claim that still carries 55700 is rejected on submission. A single missed superbill template can turn every prostate biopsy in a practice into a denied claim until someone catches it. Across the billing companies we vet, the ones that handled this transition cleanly are the ones that pushed template updates to their clients before January 1, not after the first denial wave hit. For context on how bundling rules work with other common urology procedures, see our breakdown of CPT 52000 and cystoscopy billing.

For a practice running a steady volume of biopsies, a stale template can hold up thousands of dollars in reimbursement in a matter of weeks. This is exactly the kind of transition where the right billing partner earns its keep.

How Does Reimbursement Change Under the New Prostate Biopsy Codes?

The 2026 Medicare Physician Fee Schedule assigns individual values to each of the nine replacement codes, and those values differ by approach and guidance complexity. In general, transperineal codes and MRI-fusion codes carry higher relative value units (RVUs) than the basic transrectal ultrasound-guided codes because the work, equipment, and time involved are greater.

Under the old 55700, a practice performing advanced MRI-fusion transperineal biopsies received the same base payment as one performing standard transrectal ultrasound-guided biopsies, plus whatever imaging guidance was billed separately. The new structure corrects that by assigning higher values to the more complex procedures. For practices that already shifted to transperineal or fusion techniques, accurate coding under the 2026 set should recover revenue that was effectively left on the table under 55700.

In our experience matching urology providers with billing partners, the practices that benefit most from this change are the ones performing a high mix of fusion biopsies. The old flat payment masked the additional work. The new codes expose it, but only if the documentation and the coding are precise enough to capture it.

What Documentation Do Urologists Need for the New Biopsy Codes?

Every operative note for a prostate biopsy performed in 2026 or later must include four elements to support the code selected. Without all four, the claim is vulnerable to a denial on review or an audit adjustment.

1. The approach: transrectal, transperineal, or in-bore. The note must state this explicitly, not imply it from the equipment list.
2. The imaging guidance: none, ultrasound only, MRI-ultrasound fusion, or in-bore CT or MRI. If fusion was used, the note should reference the prior MRI and the fusion platform.
3. The sampling method: systematic (template-based cores), targeted to a specific lesion identified on imaging, or both systematic and targeted in the same session.
4. The lesion count for targeted biopsies: if more than one lesion was targeted, each additional lesion supports reporting +55715 as an add-on code. The note must describe each lesion separately.

Under 55700, documentation could be sparse and the claim would still pay. That tolerance is gone. The most common issue we see providers run into now is an operative note that describes the biopsy in general terms without specifying the approach or the guidance, which forces the coder to query the physician and delays the claim.

Common Mistakes That Cause 55700 Denials in 2026

Every urology practice performing prostate biopsies in 2026 faces the same handful of avoidable errors. These are the ones we see surface most often across the billing companies in our network.

• Submitting the deleted code. 55700 no longer exists in the 2026 CPT code set. Any claim carrying it is rejected automatically. The fix is a superbill and EMR template audit that removes 55700 and loads the new code family.
• Billing imaging guidance separately. Ultrasound guidance (76872) and MRI guidance are now bundled. Reporting them alongside 55707 through 55715 triggers a denial for the guidance line and may flag the practice for unbundling.
• Choosing the wrong replacement code. Reporting 55707 (transrectal, ultrasound) when the procedure was actually transperineal with fusion (55710) results in either underpayment or a payer audit. The approach and the guidance must match.
• Missing the add-on for additional lesions. If the urologist targeted two or three lesions, each one beyond the first should be reported with +55715. Skipping it leaves revenue on the table.
• Vague operative notes. A note that says “prostate biopsy performed” without specifying the approach, guidance, and sampling method does not support any of the new codes. The coder is forced to query, and the claim sits.

For practices that also bill urethral biopsy (CPT 53200) in the same sessions, confirm the NCCI edits for each code pair. Bundling rules differ depending on the procedure combination.

CPT 55700 vs. 55705 vs. 54500: Which Code Applies?

These three codes sit close together in the urology code set and get confused regularly, especially now that 55700 is deleted. Here is how they differ.

• 55700 (deleted): Was the catch-all prostate needle biopsy code through December 31, 2025. No longer billable.
• 55705 (revised for 2026): Prostate biopsy performed without any imaging guidance. This is the code for the rare scenario where a biopsy is done without ultrasound or MRI. It was revised, not newly created, so it existed before but now serves a narrower role.
• 54500: Testicular needle biopsy. Different organ, different code family. 54500 is the testis; the 55700 replacement codes are the prostate. If your practice performs both, keep them in separate sections of the superbill to avoid selection errors.

CPT codes and descriptors are maintained by the American Medical Association and are provided here for reference. Bundling, modifier, and global-period rules vary by payer and by Medicare contractor, so verify against current CPT guidelines, the current NCCI edit file, and payer policies before billing.

Frequently Asked Questions

Next Steps

• New to urology procedure coding? Start with our urology CPT coding guide for how these codes fit together.
• Need the cystoscopy bundling rules? See CPT code 52000 for the diagnostic cystoscopy breakdown.
• Billing testicular biopsies alongside prostate biopsies? Review CPT 54500 to keep the code families separate.
• Ready to hand coding off to a specialist? Get matched with vetted urology billing companies that code the 2026 prostate biopsy set correctly.