CPT 10005Surgery

Fna bx w/us gdn 1st les

CPT code 10005 represents a fine needle aspiration (FNA) biopsy performed with ultrasound guidance to sample tissue from the first lesion or abnormal area. The ultrasound helps the physician accurately guide a thin needle into the suspicious area to collect cells for laboratory analysis.

Showing rates for

National Average

Base Medicare rate

$129.06

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

1.46

PE RVU (NF)

2.37

MP RVU

0.16

Total RVU

3.99

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

NCCI bundling edits

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Billing tips

Bill 10005 only for the first lesion; use add-on code 10006 for each additional lesion biopsied during the same session
Impact: Proper sequencing prevents denials and ensures additional $45-65 payment per additional lesion with code 10006
Verify the setting of service before billing - use place of service 22 for hospital outpatient to receive $129.06 versus POS 11 for office which reimburses $70.19
Impact: Correct POS coding affects reimbursement difference of $58.87 per procedure due to facility versus non-facility rate differential
Document the real-time ultrasound guidance explicitly in the procedure note, including imaging of needle placement and confirmation of needle position within the target lesion
Impact: Without documentation of imaging guidance, payers may downcode to 10021 (non-guided FNA), reducing payment by approximately $40-50
Ensure separate billing for pathology interpretation (88172-88173) as this is not included in the 10005 procedure code
Impact: Pathology codes add $30-80 to total reimbursement and are separately billable by the pathologist or laboratory
Appeal denials for medical necessity by providing imaging reports showing the lesion characteristics, size, and clinical indication for tissue diagnosis
Impact: Successful appeals recover the full $70.19-129.06 payment; approximately 60-70% of medical necessity denials are overturned with proper documentation
Bill the appropriate ultrasound code (76942) only if performed by a different physician or when allowed by payer policy, as imaging guidance is typically bundled with 10005

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 10005 in 2025?

The 2025 Medicare national average reimbursement for CPT 10005 is $129.06 for non-facility settings and $70.19 for facility settings. The code has a total RVU value of 3.99, consisting of 1.46 work RVU, 2.37 non-facility PE RVU (0.55 facility PE RVU), and 0.16 malpractice RVU.

Can I bill CPT 10005 and 76942 together for ultrasound-guided FNA?

No, CPT 76942 (ultrasound guidance for needle placement) is bundled into CPT 10005 and should not be separately billed by the same provider. The imaging guidance component is included in the reimbursement for 10005. Billing both codes together will result in denial of 76942 per NCCI edits.

What is the difference between CPT 10005 and 10021?

CPT 10005 is for fine needle aspiration with ultrasound guidance, while 10021 is for FNA without imaging guidance (palpation-guided). Code 10005 requires documentation of real-time ultrasound visualization during needle placement and reimburses approximately $40-50 more than 10021 due to the imaging guidance component.

How do I bill for multiple lesions biopsied during the same session?

Use CPT 10005 for the first lesion and add-on code 10006 for each additional lesion biopsied with ultrasound guidance during the same session. Code 10006 cannot be billed alone and must be reported with 10005. Document each lesion location separately to support billing multiple sites.

What documentation is required to support medical necessity for CPT 10005?

Documentation must include clinical indication (concerning imaging findings or palpable abnormality), lesion characteristics justifying biopsy, relevant patient history or risk factors, and reference to applicable guidelines supporting tissue diagnosis. Imaging reports showing suspicious features, lesion size, or interval growth strengthen medical necessity.

Does CPT 10005 include the pathology interpretation?

No, CPT 10005 covers only the procedure of obtaining the tissue sample with ultrasound guidance. The pathology interpretation is billed separately using CPT codes 88172-88173 for fine needle aspiration cytology and is typically submitted by the pathologist or laboratory performing the interpretation.

What modifiers are commonly used with CPT code 10005?

Common modifiers include modifier 59 for distinct procedural service on separate lesions, RT/LT for laterality on paired organs, modifier 25 for separate E/M service on the same day, modifier 76 for repeat procedure by same physician, and modifier 52 for reduced services if procedure is discontinued before completion.