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A New Era of Prostate Biopsy Coding

A New Era Of Prostate Biopsy Coding
For years, most prostate biopsies—whether transrectal, transperineal, ultrasound-guided, fusion, or saturation—were billed collectively within a small set of CPT codes. One of the core codes , 55700, covered biopsy of the prostate, regardless of approach. 1

That changes in 2026. 1

What’s new?

  • CPT 55700 is being discontinued. 1
  • Nine new CPT codes will be added in for prostate biopsies. 1
  • Codes will now differentiate by factors such as:
    • Transrectal vs transperineal approach 1
    • MRI-fusion-guidance 1
    • In-bore biopsy 1
    • And others

These additions reflect the current biopsy landscape, including the broader use of advanced imaging and transperineal approaches.

Transperineal Biopsy Updates 2

Why This Matters To Urologists:

Beyond the financial implications of these new CPT codes, it’s also worthwhile for clinicians to consider the broader clinical advantages of the transperineal approach. These include:

  • Minimized Infection Risks: A 2022 systematic review found that transrectal prostate biopsies are associated with a 0.3-0.8% post-biopsy sepsis rate. That same review found that transperineal prostate biopsies resulted in an overall sepsis rate of approximately 0.09-0.13%, with multiple studies reporting zero or near-zero cases of sepsis. 3
  • Expanded Prostate Access: TP biopsies have also demonstrated improved sampling of areas such as the anterior and apical regions. 4
  • Flexible Anesthesia Options: Transperineal biopsies can be performed effectively under local anesthesia in an outpatient setting. This allows urologists to achieve patient tolerability and minimal complications without requiring hospital-based resources. 5

For practices considering the switch, the new coding structure provides a clear financial incentive to adopt a technique that already offers substantial clinical benefits for both the patient and the provider.

The Bottom Line

2026 marks a reimbursement tipping point in prostate biopsy care.

For the first time, CMS reimbursement:

  • Reflects higher reimbursement values for transperineal biopsy codes. 2
  • Assigns distinct reimbursement for procedures involving targeted or advanced imaging modalities. 1
  • Moves away from broad/generic coding toward specific clinical distinctions. 1

Want to Achieve Even Greater Savings? Consider TP Pivot Pro:

TP Pivot Pro™ disposable needle guides enable a freehand, minimally invasive technique to ultrasound-guided transperineal prostate biopsies. As mentioned, this approach can be performed under local anestehsia and offers improved access to prostate zones. 4 5 Evidence indicates that freehand transperineal biopsies can be safely conducted in an office setting with local anesthesia, lowering costs associated with operating theatre, training, and resources. 5 6 Additionally, reducing post-biopsy infections presents additional economic benefits, with literature estimating the cost of sepsis after prostate biopsy averaging anywhere from $8,672 to $19,000. 7

Ultimately, the choice of biopsy approach and the selection of any associated reimbursement codes remain the responsibility of the healthcare professional, who must exercise independent clinical judgment based on the individual patient’s clinical circumstances, institutional protocols, and applicable payer requirements.

References:

#1: Prepare for New Prostate Procedure CPT Codes in 2026 (Codify by AAPC): https://www.aapc.com/codes/coding-newsletters/my-urology-coding-alert/urology-coding-prepare-for-new-prostate-procedure-cpt-codes-in-2026-179842-article?srsltid=AfmBOooi1PNdOY_dcq_QD_-r94O5gO_PxlElMMUTecJ9H9ZzmBXwvsaG

#2: Physician Fee Schedule – HCPCS Codes 55705-55712, 55715 – January 2026 (CMS. https://www.cms.gov/medicare/physician-fee-schedule/search?Y=0&T=4&HT=2&CT=0&H1=55705&H2=55715&M=5)

#3: Castellani D, Pirola GM, Law YXT, et al. Infection Rate after Transperineal Prostate Biopsy with and without Prophylactic Antibiotics: Results from a Systematic Review and Meta-Analysis of Comparative Studies. The Journal of urology. 2022;207(1):25-34. doi:10.1097/JU.0000000000002251

#4: Ortner G, Tzanaki E, Rai BP, Nagele U, Tokas T. Transperineal prostate biopsy: The modern gold standard to prostate cancer diagnosis. Turkish journal of urology. 2021;47(Supp. 1):S19-S26. doi:10.5152/tud.2020.20358

#5: Hong A, Hemmingway S, Wetherell D, Dias B, Zargar H. Outpatient transperineal prostate biopsy under local anaesthesia is safe, well tolerated and feasible. ANZ journal of surgery. 2022;92(6):1480-1485. doi:10.1111/ans.17593

#6: Roberts MJ, Arora S, Yao HH, et al. Transperineal prostate biopsy under local vs general anaesthesia: a cost-effectiveness analysis. BJU international. 2025;136(1):128-134. doi:10.1111/bju.16722

#7: Gross MD, Alshak MN, Shoag JE, et al. Healthcare Costs of Post-Prostate Biopsy Sepsis. Urology. 2019;133:11-15. doi:10.1016/j.urology.2019.06.011

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