CPT 10007Surgery

Fna bx w/fluor gdn 1st les

CPT 10007 covers a fine needle aspiration (FNA) biopsy of the first lesion performed under fluoroscopic (real-time X-ray) guidance, where a thin needle removes tissue samples for testing. This is a minimally invasive diagnostic procedure used to determine if a mass or lesion is cancerous or benign.

Showing rates for

National Average

Base Medicare rate

$294.03

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

1.81

PE RVU (NF)

7.05

MP RVU

0.23

Total RVU

9.09

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

NCCI bundling edits

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Billing tips

Always verify place of service coding—POS 22 (outpatient hospital) triggers the facility rate of $86.04 while POS 11 (office) supports the non-facility rate of $294.03
Impact: $207.99 payment difference (242% higher in non-facility setting)
Document and save all fluoroscopic images with the permanent medical record; at minimum, save representative images showing needle placement and target lesion visualization
Impact: Prevents downcoding to 10021 (palpation-guided FNA) which pays approximately $100-150 less, and protects against audit recoupment
Bill 10008, 10009, 10010, 10011, or 10012 for each additional lesion biopsied during the same session rather than multiple units of 10007
Impact: Using add-on codes ensures proper payment; billing multiple units of 10007 will result in denial or 50% reduction
Separately report imaging guidance with the appropriate radiology supervision and interpretation code only when distinct from the included fluoroscopic guidance
Impact: Fluoroscopy is bundled into 10007; billing 77002 separately will result in denial as a component of the primary procedure
Document the specific medical necessity for fluoroscopic guidance rather than ultrasound or CT guidance, including lesion location, depth, and visibility factors
Impact: Prevents payer challenges questioning modality choice and supports medical necessity if alternative guidance codes are queried
When pathology results are insufficient and repeat FNA is required, document why initial sample was inadequate and ensure separate date of service or use modifier 76 with strong documentation

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 10007 in 2025?

The 2025 Medicare national average payment for CPT 10007 is $294.03 in the non-facility (office) setting and $86.04 in the facility (hospital outpatient) setting. The significant difference reflects that facility payments only cover the professional work, while non-facility payments include practice expense for equipment and supplies.

How many RVUs is CPT code 10007 worth?

CPT 10007 has a total of 9.09 RVUs, consisting of 1.81 work RVUs, 7.05 non-facility practice expense RVUs (0.62 facility PE RVUs), and 0.23 malpractice RVUs based on the 2025 Medicare Physician Fee Schedule.

Can I bill CPT 10007 multiple times for biopsies of multiple lesions?

No, CPT 10007 should only be billed once for the first lesion. For each additional lesion biopsied during the same session, you must use the appropriate add-on codes: 10008, 10009, 10010, 10011, or 10012 depending on the imaging modality used. Billing 10007 multiple times will result in denial or significant payment reduction.

What is the difference between CPT 10007 and 10021?

CPT 10007 is for fine needle aspiration performed with fluoroscopic (X-ray) guidance, while 10021 is for FNA performed without imaging guidance (palpation only). Code 10007 requires documentation of fluoroscopic visualization and saved images, and reimburses significantly higher due to the technical component of imaging guidance.

Do I need to bill separately for the fluoroscopic guidance with CPT 10007?

No, fluoroscopic guidance is included in CPT 10007 and should not be billed separately. Billing 77002 (fluoroscopic guidance) or other imaging supervision codes with 10007 will result in denial due to bundling edits, as the imaging is considered an integral component of the procedure.

What modifiers are commonly used with CPT code 10007?

Common modifiers for 10007 include modifier 26 (professional component only), TC (technical component only), 59 or XS (distinct procedural service for separate anatomic sites), and 76 (repeat procedure by same physician). Modifier choice depends on the practice setting, component billing arrangements, and whether multiple distinct lesions are biopsied.

What documentation is required to support billing CPT 10007?

Required documentation includes the medical necessity for biopsy, specific lesion location and size, detailed description of fluoroscopic guidance used, needle type and gauge, number of passes, specimen adequacy assessment, and most critically, saved fluoroscopic images showing needle placement. Lack of saved images is a common reason for downcoding to palpation-guided codes or denial upon audit.