CPT 10009Surgery

Fna bx w/ct gdn 1st les

CPT code 10009 covers a CT-guided fine needle aspiration (FNA) biopsy of the first lesion, where a radiologist uses CT imaging to guide a thin needle into a suspicious mass to extract tissue samples for laboratory analysis.

Showing rates for

National Average

Base Medicare rate

$405.63

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

2.26

PE RVU (NF)

10.06

MP RVU

0.22

Total RVU

12.54

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Always verify place of service and bill with appropriate modifier 26/TC split in facility settings versus global billing in non-facility settings
Impact: $301.80 difference between settings - incorrect POS coding can result in overpayment recovery or underpayment
Use add-on code 10010 for each additional lesion biopsied during the same session with CT guidance, never bill 10009 twice
Impact: 10010 adds approximately $102-156 per additional lesion; billing 10009 multiple times will trigger bundling edits and denials
Document real-time CT guidance explicitly in the operative note, including number of CT images obtained, confirmation of needle position, and adjustments made under CT visualization
Impact: Absence of CT guidance documentation can result in downcoding to non-guided FNA (10021) with $250+ payment reduction
Submit pathology reports with the claim for initial submission when possible, especially for Medicare and commercial payers with prepayment review programs
Impact: Reduces audit requests by 40-60% and accelerates payment by 10-15 days on average
Check LCD/NCD coverage requirements for specific anatomic sites; some Medicare contractors require prior authorization for certain indications
Impact: Prevents denials for non-covered services; retroactive denials can cost the full $405.63 if authorization not obtained
Bill the appropriate E/M service separately with modifier 25 only when a significant, separately identifiable evaluation occurs beyond the decision for biopsy
Impact: Can add $75-200 when appropriately documented, but inappropriate use triggers audits and modifier 25 scrutiny

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 10009?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is the difference between CPT 10009 and 10021 for fine needle aspiration?

CPT 10009 is specifically for CT-guided FNA biopsy with imaging guidance included in the code, while 10021 is for FNA without imaging guidance (palpation-guided). The CT guidance in 10009 commands significantly higher reimbursement ($405.63 vs approximately $155 for 10021) but requires documentation of real-time CT imaging used for needle localization and positioning.

How much does Medicare pay for CPT code 10009 in 2025?

Medicare pays $405.63 for CPT 10009 in non-facility settings (physician office with owned equipment) and $103.83 for the professional component only in facility settings in 2025. The facility receives approximately $301.80 for the technical component when the service is split-billed in hospital or ASC settings.

Can I bill CPT 10009 multiple times for biopsies of multiple lesions?

No, CPT 10009 should only be billed once per session for the first lesion biopsied. For each additional lesion biopsied with CT guidance during the same encounter, use add-on code 10010. Billing 10009 multiple times will result in bundling edits, denials, and potential fraud flags.

What modifiers are required when billing CPT 10009 in a hospital outpatient setting?

In hospital outpatient settings, the physician must append modifier 26 (professional component) to bill only for interpretation and guidance services, as the hospital bills separately for the technical component with modifier TC. Failure to use modifier 26 in a facility setting results in incorrect global billing and potential overpayment recoupment.

Does CPT 10009 require prior authorization from Medicare or commercial payers?

Medicare generally does not require prior authorization for 10009, but some Medicare Administrative Contractors have Local Coverage Determinations (LCDs) requiring documentation of specific indications. Many commercial payers do require prior authorization for CT-guided procedures, particularly for certain anatomic sites like lung or liver biopsies. Always verify payer-specific requirements before scheduling.

What documentation is needed to prevent denials for CPT 10009?

Essential documentation includes: pre-procedure imaging showing the target lesion, informed consent, detailed operative note describing real-time CT guidance with number of images obtained, lesion location and size, number of needle passes, confirmation of needle position via CT, specimen adequacy, post-procedure imaging for complications, and the pathology report. Absence of explicit CT guidance documentation is the most common reason for denial or downcoding.

Can I bill an E/M visit on the same day as CPT 10009?

Yes, but only if a significant, separately identifiable evaluation and management service is performed beyond the typical pre-procedure assessment. The E/M must be documented separately and billed with modifier 25. The E/M should represent a distinct diagnostic or management decision (such as initial evaluation of new symptoms) rather than just the decision to perform the biopsy, which is included in the procedure's global fee.