If your chargemaster still has 55700 sitting there like nothing changed, stop. For dates of service on or after January 1, 2026, that code is deleted.

Prostate biopsy coding got rebuilt. One old “any approach” code became a family that asks three basic questions:

1. Transrectal or transperineal?
2. What imaging guidance was used?
3. Was this a systematic/sextant biopsy, a targeted lesion biopsy, or both?

Get those three right, and the new codes make sense. Get them wrong, and you will see denials, wrong payments, and a lot of rework.

What changed on January 1, 2026

Per the American Urological Association’s summary of the CY 2026 Medicare Physician Fee Schedule final rule:

• CPT 55700 (needle or punch biopsy of the prostate, any approach) was deleted
• CPT 55705 was revised (incisional biopsy, any approach)
• Nine new codes were created: 55707 through 55715
• CPT 55706 (transperineal stereotactic template saturation sampling) stayed in the family
• CMS accepted the RUC-recommended work and practice expense RVUs for the prostate biopsy family for 2026

AUA also says it is already working with the CPT Editorial Panel to revise this set again, and expects the 2026 family may only last about a year. So learn it now, but keep an eye on 2027.

The new code map, in plain English

Think in rows, not in memorized numbers.

Transrectal ultrasound-guided

• 55707: Transrectal US-guided biopsy for systematic/sextant work, or US-localized lesion(s)
• 55708: Transrectal US-guided systematic/sextant biopsy with MRI fusion, first targeted lesion
• 55711: Transrectal MRI-US fusion, targeted lesion(s) only, first lesion

Transperineal ultrasound-guided

• 55709: Transperineal US-guided biopsy for systematic/sextant work, or US-localized lesion(s)
• 55710: Transperineal US-guided systematic/sextant biopsy with MRI fusion
• 55712: Transperineal MRI-US fusion, targeted lesion(s) only, first lesion

In-bore CT/MRI-guided

• 55713: In-bore CT/MRI-guided systematic/sextant work plus additional targeted, first targeted
• 55714: In-bore CT/MRI-guided targeted only, first targeted

Add-on

• 55715: Each additional MRI-fusion or in-bore targeted lesion

AUA-published work RVUs for this family (CMS accepted the RUC values) include examples like 55707 at 2.63, 55708 at 3.39, 55709 at 3.23, 55710 at 3.81, 55711 at 2.61, 55712 at 3.10, 55713 at 4.00, 55714 at 3.62, and 55715 at 1.05. Use your current CMS fee schedule lookup for dollars in your locality. Do not price from memory.

What your chart has to capture now

Old 55700 was forgiving. The new family is not.

Before charge entry, the note or op report should answer:

• Approach: transrectal or transperineal?
• Guidance: ultrasound only, MRI-ultrasound fusion, or in-bore CT/MRI?
• Pattern: systematic/sextant, targeted only, or systematic plus targeted?
• How many MRI-marked targeted lesions were sampled, if fusion or in-bore targeting was used?

If the scheduler only wrote “prostate biopsy,” that is not enough anymore.

Weak documentation

“US-guided prostate biopsy performed.”

That could be 55707, 55709, or something else. Nobody can tell.

Stronger documentation

“Transperineal ultrasound-guided prostate biopsy with MRI-ultrasound fusion. Systematic sampling performed. Targeted sampling of one MRI-marked lesion in the left peripheral zone. Proceeded as planned.”

That points cleanly toward the fusion + systematic path on the transperineal side, with 55715 only if more than one MRI-marked targeted lesion was sampled.

Common mistakes to stop now

Leaving 55700 active in the EHR

Hard-stop it for 2026 dates of service. If someone can still pick it, someone will.

Billing from habit instead of the report

“We always did 55700 + ultrasound” is not a 2026 workflow. Read the approach and guidance every time.

Counting ultrasound-only lesions like fusion targets

55715 is for additional MRI-fusion or in-bore targeted lesions. Do not invent extra add-ons because the ultrasound found another area during the case. Follow the code family rules and the operative detail.

Ignoring add-on logic

The “first targeted lesion” is built into several base codes. Extra MRI-marked targeted lesions are where 55715 belongs. If you bill 55715 with no first-lesion story in the note, expect trouble.

Assuming old ultrasound combinations still pay the same way

AUA notes that 55700 and 76872 (transrectal ultrasound) were both sent to the CPT Editorial Panel as part of this rebuild. Do not assume your old “biopsy + separate TRUS” ticket still works the same way in 2026.

Recode from the operative and imaging report. Check current CPT parentheticals and the 2026 NCCI edits before you keep old charge tickets alive. If ultrasound is diagnostic only and truly separate from the biopsy encounter, that is a different question. Do not guess. Read the note and the current edits.

A simple charge-entry decision tree

Use this at the desk:

1. Is the date of service in 2026 or later? If yes, no 55700.
2. Was this an incisional biopsy? Look at revised 55705.
3. Was this transperineal stereotactic template saturation sampling? Look at 55706.
4. Otherwise ask:
   • Transrectal or transperineal?
   • US only, MRI-US fusion, or in-bore CT/MRI?
   • Systematic/sextant, targeted only, or both?
5. If fusion or in-bore targeting was used, count MRI-marked targeted lesions.
   • First lesion is in the base code
   • Each additional qualifying lesion may support 55715
6. Only then drop the charge.

Tape that next to the biopsy charge screen for a month. It will save callbacks.

Examples your team can practice with

Example 1

Transrectal ultrasound-guided systematic biopsy. No MRI fusion.

Likely path: 55707.

Example 2

Transrectal ultrasound-guided systematic biopsy with MRI fusion of one marked lesion.

Likely path: 55708.

Example 3

Transperineal MRI-US fusion biopsy of two MRI-marked lesions, targeted only, no systematic sampling.

Likely path: 55712 for the first targeted lesion, plus 55715 for the additional lesion, if the note supports it.

Example 4

In-bore MRI-guided targeted biopsy of one lesion.

Likely path: 55714.

These are examples for training, not a substitute for the operative report. Always code the case in front of you.

Payment notes that matter in 2026

A few PFS facts affect how this feels in the bank account:

• The new biopsy codes that took effect January 1, 2026 are among the services exempt from the CY 2026 -2.5% efficiency adjustment that hits many older non-time-based codes.
• Facility vs office practice expense still matters. AUA’s read of the final rule points to facility PE pressure for urology and a relative lift in non-facility settings. Model your own mix.
• CMS accepted RUC values for this biopsy family for 2026, but AUA expects more code-set revision work for 2027. Watch proposed-rule season.

Also remember: Category I status on other new urology codes does not automatically mean every commercial payer is ready. Biopsy is the main topic here, but if your shop also added codes like Aquablation or other 2026 Category I procedures, check payer policies separately.

What to do in your shop this week

1. Inactivate 55700 for 2026 dates of service.
2. Load 55707–55715, plus confirm 55705 and 55706 are mapped correctly.
3. Update biopsy order sets and operative templates so approach, guidance, systematic vs targeted, and lesion count are required fields.
4. Train MAs, schedulers, and billers on the three questions: approach, guidance, pattern.
5. Pull the last 20 biopsy claims. If any 2026 claim still has 55700, correct and resubmit.
6. Recheck whether old ultrasound guidance add-on habits are still valid under current CPT/NCCI rules before the next denial cycle.
7. Put a 2027 watch on the AUA/CPT biopsy revisions so you are not surprised again.

Build the op note so billing can finish the claim

If physicians hate long templates, keep it short. Make these fields required:

1. Approach: transrectal / transperineal
2. Guidance: US only / MRI-US fusion / in-bore CT or MRI
3. Sampling pattern: systematic/sextant / targeted only / both
4. Number of MRI-marked targeted lesions sampled
5. Laterality or zone detail for targeted lesions when available

That is enough for most charge-entry decisions.

Sample template language

“Approach: ____. Guidance: ____. Systematic sampling: yes/no. Targeted MRI-marked lesions sampled: __. Zones/laterality: ____.”

Train the scribe or MA to fill those blanks before the case leaves the room. It is faster than a denial later.

Denial triage when something still rejects

If a 2026 biopsy claim comes back wrong, check in this order:

1. Is 55700 still on the line? If yes, that is the first fix.
2. Does the code match approach + guidance + pattern in the note? If not, recode from the report.
3. Did someone add 55715 without a first targeted lesion story? Fix the add-on logic.
4. Are old ultrasound guidance codes still hitchhiking? Check current CPT/NCCI before you fight the payer.
5. Is this commercial policy lag? Some payers load new families late. Send the op note, the CPT map, and AUA/CMS timing.

Keep a one-page cheat sheet at the desk with the nine new codes. Most of these denials are mapping problems, not medical-necessity mysteries.