From Confusion to Compliance: A Urologist’s Quick-Start Guide to the 2026 Prostate Biopsy CPT® Update

As of January 1, 2026, the long-standing prostate biopsy billing code CPT® 55700 has been retired by the American Medical Association and replaced with a more detailed set of procedure-specific CPT® codes. These updates distinguish prostate biopsy procedures by approach, imaging guidance, and whether MRI-identified lesions are targeted.

The update reflects current prostate cancer biopsy practice, where MRI–ultrasound fusion biopsy plays an increasingly important role in detecting high-grade disease. For many practices, the change affects far more than billing.

Practices still relying on ultrasound guidance only will see lower reimbursement and doctors traveling to ASCs will see up to $300 or more lower reimbursement per procedure than they can capture in-office.

The new codes better support MRI-guided biopsies, making in-office fusion biopsy profitable with the Navigo Fusion pay-per-procedure program. Bringing fusion in-house reduces stacked scheduling, captures increased per-procedure revenue, reduces offsite travel and time-consuming OR room turns, and unbillable time with cancellations and delays. And it supports fusion access for all patients and clearer documentation for prostate biopsy CPT® codes that now demand “per biopsy” documentation.

For doctors who own ASCs, the ASC CMS reimbursement for biopsies increased significantly, which supports ASCs purchasing equipment to give doctors anytime access for scheduling patients and increase revenue generated from biopsies.

For hospitals, reimbursement also increased significantly, allowing even small rural hospitals to acquire equipment to provide better access to their patients locally, reduce patient travel, and capture MRI and pathology revenues.

To help teams prepare, UC-CARE developed a CPT® quick-reference guide. The new code structure that defines prostate biopsy procedures with far greater specificity. Understanding these distinctions is the first step in preparing practices for a smooth transition.

The New Coding Landscape

The shift moves coding away from a one-size-fits-all model and toward a format that mirrors how prostate cancer is diagnosed today. These fall into distinct classifications:

• Non-imaging biopsies: Standard needle/punch sampling without ultrasound or MRI guidance.

• New codes include:

  • 55705 Biopsy, prostate, any approach, nonimaging-guided

• Ultrasound-guided sextant biopsies: Transrectal or transperineal approaches using ultrasound to localize regions of interest.

• New non-Fusion codes include:

  • 55707 Biopsy, prostate, transrectal, ultrasound-guided (i.e., sextant, ultrasound localized discrete lesion[s])

  • 55709 Biopsy, prostate, transperineal, ultrasound-guided (i.e., sextant, ultrasound localized discrete lesion[s])

  • These codes would also be used for Cognitive Fusion, as the MRI-Fusion codes are only appropriate when fusion equipment is used to assist the doctor with targeting lesions.

• MRI-ultrasound fusion–guided targeted biopsies: Procedures that use pre-acquired MRI merged with real-time ultrasound to directly sample MRI-identified lesions, now defined separately because target biopsies detect more clinically significant cancers than systematic sampling.

• New Fusion codes include:

  • Transrectal Fusion Approach

    • 55708 Biopsy, prostate, transrectal, ultrasound-guided (i.e., sextant) with MRI-fusion-guidance, first targeted lesion

    • 55711 Biopsy, prostate, transrectal, MRI-ultrasound-fusion-guided, targeted lesion(s) only, first targeted lesion

  • Transperineal Fusion Approach

    • 55710 Biopsy, prostate, transperineal, ultrasound-guided (i.e., sextant) with MRI-fusion-guidance, first targeted lesion

    • 55712 Biopsy, prostate, transperineal, MRI-ultrasound-fusion-guided, targeted lesion(s) only, first targeted lesion

  • Ask your coding specialist how to bill if you use fusion equipment to create a 3D model to better sample all areas of the prostate even if no targeted lesions are identified on MRI.

  • Extra targeted biopsies with either MRI-Fusion approach are also reimbursed. This code is only used for distinct lesions – not for multiple biopsies taken from one target.

    • 55715 Biopsy, prostate, each additional, MRI-ultrasound fusion or in-bore CT-MRI-guided targeted lesion

Anytime Access to Fusion is Paramount to Capitalizing on 2026 Reimbursement

The affordable pay-per-procedure Navigo 4D Fusion Navigation System was designed for exactly this shift, giving practices an in-office fusion workflow – or the ability to own premium fusion equipment in their ASC or local hospital so it is available at all times for scheduling providers and patients.

Navigo is the only real-time 4D fusion management system that automatically accounts for patient motion, ultrasound settings changes and automated biopsy marking with no hand or pedal. Performance data underscores Navigo’s capabilities. MRI-targeted biopsies performed with Navigo identified prostate cancer in 70% of patients, with nearly half of those cases showing clinically significant disease.¹

Better Documentation to Support New CPT® Codes

Navigo also supports stronger documentation. The system documents both targeted and structured sextant biopsy sampling with high accuracy automatically with no user intervention, ensuring that procedural documentation reflects the clinical reality of each case, supports treatment planning and active surveillance tracking and new CPT® billing requirements.

Explore the 2026 Prostate Biopsy CPT® Codes

Click here to view the 2026 AMA CPT® biopsy codes.

To receive detailed 2026 CMS prostate biopsy reimbursement information by code and site of care, schedule a discovery call with UC-Care. During the conversation, we’ll review reimbursement updates and discuss how UC-Care’s extremely affordable MRI-fusion technology can help practices take advantage of the new CPT® structure to increase revenue, optimize their 2026 bottom line, and improve workflow efficiency across physician offices, ASCs, and hospital settings.

Disclaimer

This information is provided for educational and informational purposes only and is not intended to constitute legal, coding, billing, or reimbursement advice. Coding, coverage, and payment policies vary by payer and are subject to change.

Final code selection, documentation, billing, and reimbursement decisions are the sole responsibility of the provider and/or practice. UC-CARE does not guarantee reimbursement outcomes or payer approval based on the use of this information.

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Sources

1. Magnier, Alexandre, et al. “Prostate cancer detection by targeted prostate biopsy using the 3D Navigo system: a prospective study.” Abdominal Radiology (2021) 46:4381–4387. https://doi.org/10.1007/s00261-021-03078-9