CPT 10004Surgery

Fna bx w/o img gdn ea addl

CPT code 10004 represents each additional fine needle aspiration (FNA) biopsy performed without imaging guidance during the same session. This is an add-on code used when a physician performs more than one needle biopsy in different sites without using ultrasound or other imaging to guide the needle.

Showing rates for

National Average

Base Medicare rate

$51.75

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.8

PE RVU (NF)

0.67

MP RVU

0.13

Total RVU

1.6

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Document each lesion's distinct anatomic location with measurements and specific site descriptions (e.g., 'right thyroid lower pole 2cm nodule' vs 'left thyroid upper pole 1.5cm nodule')
Impact: Reduces denial risk by 65% and supports medical necessity for multiple site sampling; crucial for modifier 59/XS justification
Always bill 10004 with primary code 10021 (first FNA without imaging); 10004 cannot be billed alone as it is an add-on code
Impact: Prevents automatic denial; ensures base reimbursement of $69.09 (10021) plus $51.75 per additional site
Report 10004 for each additional lesion biopsied, with no CMS-imposed limit on units when medically necessary and documented
Impact: Maximizes reimbursement; billing 3 total sites yields $172.59 vs $69.09 for single site (150% increase)
Bill facility rate ($42.05) when performed in hospital or ASC; non-facility rate ($51.75) only applies to office settings where practice absorbs overhead costs
Impact: Incorrect setting designation causes $9.70 underpayment or overpayment per unit; triggers audit flags
Do not bill 10004 with imaging-guided FNA codes (10005-10012); these are separate code families with different reimbursement structures
Impact: Prevents bundling denials and compliance violations; imaging-guided codes reimburse higher but require documentation of imaging necessity
Include pathology report confirmation showing distinct specimens from separate sites; label each specimen container with specific anatomic location
Impact: Provides audit-proof documentation; reduces recoupment risk and supports payment of multiple units

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 10004 in 2025?

The 2025 Medicare national average reimbursement for CPT 10004 is $51.75 for non-facility settings and $42.05 for facility settings. The total RVU is 1.6 (0.8 work RVU, varying PE RVUs by setting, and 0.13 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

Can CPT 10004 be billed alone without another CPT code?

No, CPT 10004 is an add-on code and must always be reported with the primary FNA code 10021 (first fine needle aspiration without imaging guidance). Billing 10004 alone will result in automatic claim denial. The primary code represents the first lesion, and 10004 represents each additional lesion.

How many units of CPT 10004 can be billed per patient encounter?

There is no CMS-imposed maximum on the number of units of 10004 that can be billed, but each unit must represent a medically necessary biopsy of a distinct, separate lesion. Most payers accept 2-4 additional sites without additional documentation, but 5+ units typically trigger review requiring detailed justification of each site's medical necessity.

What is the difference between CPT 10004 and 10005?

CPT 10004 is for additional fine needle aspiration biopsies performed without imaging guidance (palpation-guided only), while CPT 10005 is for the first FNA biopsy performed with imaging guidance (ultrasound, fluoroscopy, CT, or MRI). Code 10005 reimburses at a higher rate due to the imaging component and technical complexity.

Do I need modifier 59 when billing multiple units of CPT 10004?

Modifier 59 or XS is typically required when NCCI edits flag potential bundling issues or when the payer's system automatically denies multiple units as duplicates. Documentation of distinct anatomic sites usually supports the modifier use. Some payers accept multiple units without a modifier if documentation clearly shows separate lesions, but appending 59/XS proactively reduces denial risk.

What documentation is needed to bill CPT 10004 for multiple thyroid nodules?

You must document each nodule's specific location (which lobe, upper/middle/lower pole), size measurements, sonographic or palpation characteristics, separate specimen labeling, and medical necessity for sampling each nodule. Reference thyroid imaging (if available) with nodule coordinates, and explain how each biopsy influences treatment decisions or staging.

Is CPT 10004 covered by Medicare and commercial insurance?

Yes, CPT 10004 is covered by Medicare and most commercial payers when medically necessary and properly documented. Coverage requires documentation of distinct lesions, medical necessity for multiple site sampling, and appropriate pairing with primary code 10021. Prior authorization may be required by some commercial payers for more than 3-4 total FNA sites.