Current Procedural Terminology (CPT®) codes, developed and maintained by the American Medical Association (AMA), are updated annually to reflect changes in medical science, technology, and practice – ensuring billing and reimbursement accuracy, relevance, and alignment with modern care.

CPT code 55700, the current standard for all types of prostate biopsy procedures, will be terminated starting January 1, 2026, to reflect significant advancements in the diagnosis of prostate disease.

New CPT Codes to Reflect MRI-Targeted Fusion Biopsy

Nine new codes will replace 55700, and one existing code will be revised to differentiate and properly reimburse for the more accurate MRI-targeted fusion biopsy and other new technologies. Practices must understand these changes to avoid disruptions in billing and reimbursement. Furthermore, practices that do not adopt MRI-targeted fusion biopsy by January ,1 such as the Navigo 4D Fusion Navigation System, significantly risk generating less revenue.

Protect Revenue by Adopting the Navigo 4D Fusion Navigation System

With low upfront costs, flexible payment options, and the ability to drive efficiency, timely patient diagnosis and other valuable diagnostic and treatment services, MRI-targeted fusion biopsy has been a strong clinical and financial growth strategy leading up to this change.

But now, MRI-guided biopsies are more than a growth strategy or a “cherry on top” of revenue—practices actually risk losing revenue if they fail to adopt the technology aligned with the new codes.

The good news? Practices can begin preparing for the new codes in 2025, before the changes officially take effect. Adopting Navigo Fusion 4D, with its unsurpassed accuracy, automated ease-of-use, and affordability through our risk-free pay-per-procedure program, can help your practice align with the new CPT® codes and significantly increase revenue next year.

Preparing for the Clinical & Operational Impact of Switching to MRI-targeted Fusion Biopsy

Practices that transition to MRI-targeted prostate biopsy will experience many clinical and operational benefits.

• Improve prostate biopsy accuracy and patient outcomes: Compared to traditional US-guided prostate biopsies, MRI fusion offers a much higher rate of accuracy and sensitivity in detecting high-grade cancers – potentially allowing for earlier diagnosis, higher quality treatment planning and improved patient outcomes.1 This is because the technology uses real-time MRI-US fusion to create a 3D image of the prostate and deliver a comprehensive, accurate picture of regions of interest that could harbor cancer.

• Align with future billing standards: By improving billing clarity for prostate biopsy services, practices that switch to the new technology before the CPT code changes will see a boost in revenue from more accurate reporting and reimbursement. However, changing billing standards takes administrative time and effort. Your practice will need to update its billing systems to reflect the code updates. Start now to ensure you have up-to-date information as soon as it is available to prevent inaccurate coding that could lead to confusing bills, delayed or denied claims, and increased out-of-pocket patient costs. Oftentimes, patient satisfaction scores reflect the billing experiences they have with your practice. Preparing for these updates now will avoid CPT code denials and patient confusion over inaccurate or unclear bills that could lower your patient satisfaction scores.

• Gain a competitive advantage with 2025 adoption of the technology: Early adopters of Navigo 4D – or those that adopt the system before the end of 2025 – will also gain a competitive advantage. As other practices scramble to adopt prostate fusion biopsy systems closer to or after the new year, your team will already be trained on how to use Navigo 4D, understand its benefits, and code for it accurately.

Schedule a consultation with UC-Care today to start integrating MRI-targeted fusion biopsy solutions at your practice as soon as possible. With the right planning and foresight, you can avoid financial and operational setbacks and pave the way for better patient outcomes in 2026.

Source:

1. Ahmed HU, El-Shater Bosaily A, Brown LC, et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet. 2017;389(10071):815-822.