CPT 10021Surgery

Fna bx w/o img gdn 1st les

CPT code 10021 represents a fine needle aspiration (FNA) biopsy of the first lesion without imaging guidance, where a thin needle extracts tissue samples from a lump or mass that can be felt by touch. This is a diagnostic procedure used to determine whether a suspicious growth is benign or malignant.

Showing rates for

National Average

Base Medicare rate

$97.69

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

1.03

PE RVU (NF)

1.84

MP RVU

0.15

Total RVU

3.02

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

NCCI bundling edits

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Billing tips

Verify no imaging guidance was used during the procedure; if ultrasound, CT, or fluoroscopy was employed, use codes 10005-10012 instead of 10021
Impact: Incorrect code selection results in denial or recoupment; image-guided codes reimburse differently ($85-$150 range depending on modality)
Bill 10021 only for the FIRST lesion; use add-on code 10004 for each additional lesion biopsied during the same session
Impact: Billing 10021 multiple times will result in denial; proper use of 10004 captures additional $47-85 per additional lesion
Document the site as non-facility (office/clinic) when applicable to capture the higher $97.69 rate versus $53.37 facility rate
Impact: Site of service differential equals $44.32 per procedure (83% higher reimbursement in non-facility setting)
Ensure documentation clearly states palpation-guided technique and absence of imaging to support code selection during audits
Impact: Prevents post-payment audits and recoupment; lacking documentation may result in downcoding to E/M only, losing $53-97 in revenue
When billing with modifier 25 for same-day E/M, document the separate decision-making process and medical necessity for the E/M service beyond the biopsy procedure
Impact: Inadequate E/M documentation results in 100% denial of E/M service (typically $75-200 in lost revenue depending on level)
Verify pathology services are billed separately by the pathologist using 88172-88173; do not include specimen interpretation in your 10021 claim
Impact: Double-billing for interpretation causes compliance issues; proper unbundling ensures clean claims and appropriate pathology reimbursement

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Frequently asked questions

What is the difference between CPT 10021 and 10005?

CPT 10021 is for fine needle aspiration biopsy performed without any imaging guidance (palpation-guided only), while 10005 is for FNA performed with ultrasound guidance. If ultrasound, CT, fluoroscopy, or MRI is used during needle placement, you must use codes 10005-10012 instead of 10021. The distinction is critical as it affects reimbursement and coding accuracy.

How much does Medicare pay for CPT code 10021 in 2025?

Medicare pays $97.69 for CPT 10021 in the non-facility (office) setting and $53.37 in the facility setting based on the 2025 national average rates. Actual payment may vary by geographic location based on local fee schedules and MAC adjustments. The 3.02 total RVUs multiplied by the 2025 conversion factor of 32.3465 determine these rates.

Can I bill an E/M code with CPT 10021 on the same day?

Yes, you can bill an E/M service with CPT 10021 on the same day if the E/M represents a separately identifiable service beyond the usual pre-procedure assessment. You must append modifier 25 to the E/M code and document that the E/M involved significant additional work, such as evaluation of other conditions or the initial decision to perform the biopsy during a problem-focused visit.

What is CPT code 10004 and when do I use it with 10021?

CPT 10004 is an add-on code for each additional lesion biopsied after the first lesion. You must bill 10021 for the first lesion, then add 10004 for each subsequent lesion biopsied during the same session. Never bill 10021 multiple times; always use the add-on code 10004 for the second, third, and any additional lesions to ensure proper reimbursement and avoid denials.

Does CPT 10021 include pathology interpretation?

No, CPT 10021 covers only the needle aspiration procedure itself. The pathologist bills separately for cytological examination using codes 88172 (cytopathology evaluation of fine needle aspirate, immediate cytohistologic study) or 88173 (interpretation and report). The physician performing the biopsy should never bill for pathology services unless they are also the interpreting pathologist.

What diagnosis codes support medical necessity for CPT 10021?

Common supporting ICD-10 codes include R22.x (localized swelling, mass and lump), D48.x (neoplasm of uncertain behavior), C50.x (malignant neoplasm of breast for breast masses), E04.x (thyroid nodules), and R59.x (enlarged lymph nodes). The diagnosis must demonstrate a palpable abnormality requiring tissue sampling. Pre-authorization requirements vary by payer and clinical scenario.

What is the global period for CPT code 10021?

CPT 10021 has a 0-day global period, meaning there are no bundled post-procedure days. Any follow-up visits for results, complications, or additional treatment are separately billable. This allows providers to bill E/M services for result discussions or management decisions made after the biopsy without restriction, unlike procedures with 10-day or 90-day global periods.