CPT 10006Surgery

Fna bx w/us gdn ea addl

CPT code 10006 covers each additional fine needle aspiration (FNA) biopsy performed with ultrasound guidance during the same session, after the first biopsy. This is an add-on code used when multiple tissue samples are taken from different sites or lesions during one procedure.

Showing rates for

National Average

Base Medicare rate

$58.22

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

PE RVU (NF)

0.7

MP RVU

0.1

Total RVU

1.8

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

NCCI bundling edits

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Billing tips

Always bill 10006 with the primary FNA code (10005, 10004, 10021, 19083, or 19085) - this is an add-on code that cannot be billed alone
Impact: Prevents 100% denial; add-on codes without primary codes are automatically rejected by Medicare and commercial payers
Document each distinct lesion location with specific anatomic landmarks, sizes, and ultrasound characteristics in the procedure note
Impact: Reduces denial rate by 40-60%; medical necessity denials are the most common reason for 10006 rejections
Bill one unit of 10006 for each additional lesion beyond the first - if three lesions are biopsied, bill the primary code once plus two units of 10006
Impact: Each properly documented additional site generates $47.87-$58.22 in revenue; underbilling costs average $100-$200 per multi-lesion procedure
Use appropriate anatomic modifiers (RT/LT) or XS modifier when biopsying multiple sites to prevent NCCI edits and bundling denials
Impact: Increases first-pass claim acceptance rate by 25-35% and reduces accounts receivable days
Verify pathology documentation confirms separate specimens were submitted with distinct labeling for each biopsy site
Impact: Correlating billing with pathology records prevents post-payment audits and recoupment demands averaging $300-$500 per audit
Check payer-specific policies on maximum billable units per session - some payers limit to 3-4 additional sites without prior authorization
Impact: Prevents denials on higher unit claims; obtaining prior auth for extensive staging biopsies protects $200+ in potential revenue

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 10006 in 2025?

The 2025 Medicare national average reimbursement for CPT 10006 is $58.22 in non-facility settings and $47.87 in facility settings. These rates are based on a total RVU of 1.8 and the 2025 conversion factor of 32.3465.

Can CPT code 10006 be billed alone or does it require another code?

CPT 10006 cannot be billed alone - it is an add-on code that must be reported with a primary FNA biopsy code such as 10005, 10004, 10021, 19083, or 19085. Billing 10006 without a primary procedure code will result in automatic claim denial.

How many times can you bill CPT 10006 on the same date of service?

You can bill CPT 10006 multiple times per session, with each unit representing one additional lesion biopsied beyond the first. For example, if five separate lesions are biopsied, you would bill the primary code once and 10006 four times. However, some payers have limits on units without prior authorization, and documentation must support medical necessity for each site.

What is the difference between CPT 10005 and 10006?

CPT 10005 is the primary code for the first fine needle aspiration biopsy with imaging guidance, while CPT 10006 is the add-on code for each additional lesion biopsied during the same session. You bill 10005 once for the first lesion, then 10006 for each subsequent lesion sampled.

What modifier should I use when billing multiple units of CPT 10006?

The most common modifiers for CPT 10006 are modifier 59 or XS to indicate distinct procedural services at different anatomic sites, and RT/LT modifiers for bilateral structures. Modifier XS is preferred by Medicare over modifier 59 for indicating separate anatomical sites and reduces audit risk.

Does CPT 10006 include ultrasound guidance in the payment?

Yes, CPT 10006 is a comprehensive code that includes real-time ultrasound guidance, imaging supervision, and interpretation for each additional biopsy. You should not separately bill ultrasound codes (76942, 76998) when performing the additional FNA biopsies, as these imaging services are bundled into the 10006 payment.

What documentation is required to bill CPT 10006 without audit risk?

Documentation must include: medical necessity for each additional site, specific anatomic location with measurements for each distinct lesion, confirmation of real-time ultrasound guidance for each biopsy, description of separate needle insertions at different locations, and pathology documentation showing separately labeled specimens. The key is proving each unit represents a different anatomic site, not repeat sampling of the same lesion.