CPT® Code 10005

Quick Reference

• Code definition: 10005 reports a fine needle aspiration biopsy of the first lesion in a session, where ultrasound guidance is used to direct the needle; the guidance component (imaging supervision and interpretation) is included in the code and cannot be separately reported.
• Key billing rule: MUE = 1; bill only one unit of 10005 per date of service. Each additional lesion biopsied with ultrasound guidance in the same session requires add-on code 10006, not a second unit of 10005.
• Modifier essentials: No -26 or -TC split applies (PC/TC indicator = 0). Modifier -59 or X-modifiers (-XS, -XU) may be needed when 10005 is billed alongside other procedures on the same date. Use -LT/-RT when laterality is relevant to payer adjudication.
• Documentation must-have: Real-time ultrasound use must be explicitly documented in the procedure note. Without this, the claim supports only 10021 (palpation-guided FNA), not 10005.
• Top confusion point: Do not separately bill 76942 alongside 10005. Ultrasound guidance is bundled into the code; billing both is an unbundling violation subject to NCCI edit denial and overpayment recovery.
• Payer alert: 10006 is packaged in the APC/ASC system; no separate ASC payment is made for the add-on. Facility and ASC billers need to account for this in RVU-based payment reconciliation.
• 2019 restructuring: Code 10022 (the predecessor, non-modality-specific FNA with imaging guidance) was deleted January 1, 2019. Any claims still using 10022 will be rejected outright.

When to Use This Code

CPT 10005 applies when a physician or other qualified clinician performs FNA biopsy on a single lesion during a session and uses ultrasound in real time to guide needle placement. The code is anatomically nonspecific; it applies equally to thyroid nodules, lymph nodes, breast masses, parotid glands, soft tissue masses, intra-abdominal lesions, and any other site where ultrasound guidance directs the needle.

Indications include evaluation of palpable or non-palpable masses where cytologic sampling is required for diagnosis, characterization of thyroid nodules per ACR TIRADS or ATA criteria, lymphadenopathy workup when malignancy or lymphoma is suspected, and breast lesions not amenable to palpation-guided sampling. The code is appropriate whether the operator is a radiologist, surgeon, endocrinologist, or other provider credentialed to perform the procedure.

Scope boundaries to keep in mind:

• Ultrasound guidance must be real-time and documented. Performing ultrasound before the procedure to localize the lesion, then withdrawing the transducer before needle insertion, does not support 10005; that scenario would support 10021 instead.
• 10005 covers only the needle aspiration component. Cytopathology evaluation (on-site adequacy assessment or final interpretation) is separately billable by the pathologist using 88172, 88173, or 88177.
• When a core needle biopsy is performed on the same lesion in the same session using the same imaging guidance type, the imaging guidance for the core biopsy is not separately reportable. When FNA and core biopsy are performed on separate lesions in the same session using the same imaging modality, both the core biopsy and its imaging guidance may be reported with modifier -59.

Provider and setting context: 10005 has a PC/TC indicator of 0, meaning it is billed as an indivisible physician service. The facility (hospital outpatient department or ASC) bills separately for resources; the proceduralist bills 10005 for the professional service. Non-facility RVUs apply when the procedure is performed in a physician office or freestanding imaging center.

Code Differentiation Table

The critical differentiator is imaging modality. Code selection depends entirely on what guidance type the procedure note documents; 10005 is correct only when ultrasound is explicitly used to direct needle placement. For multi-lesion sessions using different modalities (e.g., ultrasound for one lesion, CT for another), both respective first-lesion codes may be reported together, each with modifier -59 on the second modality's code per CPT guidelines.

flowchart TD
    A[FNA Biopsy Performed] --> B{Real-time imaging used?}
    B -- No --> C[10021 first lesion\n10004 each additional]
    B -- Yes --> D{Imaging modality?}
    D -- Ultrasound --> E[10005 first lesion\n10006 each additional]
    D -- Fluoroscopy --> F[10007 first lesion\n10008 each additional]
    D -- CT --> G[10009 first lesion\n10010 each additional]
    D -- MR --> H[10011 first lesion\n10012 each additional]

Billing & Modifier Rules

Modifier -26 / -TC: Not applicable. PC/TC indicator = 0; 10005 is a physician service code and cannot be split into professional and technical components.

Modifier -50 (Bilateral): Not applicable. The bilateral surgery indicator is 0; the 150% bilateral adjustment does not apply.

Modifier -51 (Multiple Procedures): Multiple procedures indicator = 2, meaning standard reduction rules apply when 10005 is billed alongside other procedures on the same day. Add-on code 10006 carries indicator = 0 and is exempt from multiple procedure reduction.

Modifier -59 and X-modifiers: Use -59 (or preferred X-modifier variants -XS, -XU) when 10005 is billed on the same date as another procedure that would otherwise be bundled or flagged by NCCI edits. This is most commonly required when FNA and core needle biopsy are performed on separate lesions using the same imaging modality; both the core biopsy and its guidance are separately reportable with modifier -59.

Modifier -LT / -RT: Informational but functionally required by some payers for lateralized structures (e.g., left thyroid lobe, right breast). Append when biopsying a paired organ where laterality affects claim adjudication.

Add-on code 10006: Report once per additional lesion. 10006 has a MUE of 3, allowing up to three add-on units (i.e., up to four total lesions in a session: one 10005 plus three 10006 units). 10006 cannot be reported standalone; it requires a primary 10005 on the same claim.

NCCI bundling: 76942 is explicitly listed in CPT parenthetical guidance as a code that may NOT be reported with 10005. Any claim pairing these two codes will be denied under NCCI edits. This is the highest-volume billing error for this procedure family and remains a recurring audit finding years after the 2019 restructuring.

Cytopathology codes: 88172, 88173, and 88177 are separately reportable and are billed by the pathologist, not the proceduralist. These are NOT bundled with 10005 and are typically submitted on a separate claim.

Documentation Essentials

The procedure note must explicitly establish that ultrasound was used in real time to guide needle placement, not merely to identify the lesion beforehand. Auditors reviewing claims for 10005 versus 10021 look specifically for language confirming the transducer was active during needle insertion.

Required documentation elements:

• Indication / medical necessity: Clinical reason for biopsy, including description of the lesion (size, location, imaging characteristics) and what diagnosis is being pursued. For thyroid nodules, ACR TIRADS or ATA category is helpful.
• Imaging guidance confirmation: Explicit statement that ultrasound guidance was used during needle placement; ideally, documentation that continuous real-time imaging was performed throughout the procedure.
• Lesion identification: Each lesion biopsied must be individually identified. If 10006 is billed, the note must document distinct lesions as separate structures, not multiple passes on the same lesion.
• Technical details: Needle gauge (22- or 25-gauge typical), number of passes, approach (e.g., freehand vs bracket technique).
• Specimen disposition: Where the aspirate was sent (cytology laboratory, on-site evaluation), whether ROSE was performed and by whom.
• Post-procedure status: Site condition, any complications, dressing applied.

Audit red flags specific to 10005:

• Documentation of palpation-guided FNA with no mention of ultrasound; auditors will downcode to 10021.
• Ultrasound referenced only in a prior imaging report or in the indication section, without procedural documentation of real-time use.
• Multiple units of 10005 billed (MUE violation); auditors will deny the additional units and may flag for broader pattern review.
• 76942 billed alongside 10005; NCCI edit will trigger automatic denial of the guidance code, and recoupment risk arises if the pattern is systematic.

Medicare, Commercial & Medicaid Payer Rules

Medicare:

There is no national coverage determination (NCD) for CPT 10005. Coverage is determined at the MAC level through local coverage determinations. Coders should verify the applicable MAC LCD for covered diagnoses, documentation requirements, and any frequency limitations beyond the MUE of 1.

The MUE for 10005 is 1 (one unit per date of service per beneficiary). The MUE for 10006 is 3.

Site-of-service payment differences apply: non-facility PE RVUs are higher than facility RVUs, reflecting that the practice expense for equipment and supplies is borne by the physician practice in an office setting. When performed at a hospital outpatient department or ASC, the facility bills separately for resources under the OPPS system.

For ASC payment, 10005 is classified as a non-office-based surgical procedure with payment based on OPPS relative payment weight. Add-on code 10006 is packaged under the APC system; no separate ASC payment is made for the add-on when billed with 10005 in an ASC setting.

APC status indicator designates 10005 as "Procedure or Service, Multiple Reduction Applies," meaning facility payment may be reduced when multiple procedures are billed in the same outpatient encounter.

Commercial payers:

Most commercial payers follow the CPT bundling rules and will deny 76942 when billed with 10005. Some payers may require prior authorization for FNA biopsy of specific anatomic sites (e.g., liver, kidney, retroperitoneum) or based on diagnosis; verify payer-specific policies before the procedure when possible.

The -59 modifier behavior varies by payer. Some commercial plans accept X-modifier variants (-XS, -XU) as preferred over -59; others require -59 specifically. Verify modifier requirements with each payer when billing 10005 alongside other same-day procedures.

Common Denials & Prevention

Denial: NCCI edit denial for 76942 billed with 10005

Billing 76942 alongside 10005 triggers an automatic NCCI edit denial. This pattern persists because coders trained under the pre-2019 system learned to bill 10022 + 76942 as a pair; 76942 is now an internal component of 10005 and is no longer separately reportable. Prevention: audit billing templates and charge description masters for any superbill line that pairs 10005 with 76942 and remove the guidance code from that pairing.

Denial: MUE exceeded (multiple units of 10005)

Submitting two units of 10005 for a two-lesion session will result in denial of the second unit. The MUE is 1. Prevention: train coders and providers that multiple lesions in the same session with the same modality require 10005 (first lesion) + one unit of 10006 per additional lesion, not multiple units of 10005.

Denial: Downcoding to 10021 due to insufficient guidance documentation

When the procedure note does not explicitly document real-time ultrasound guidance during needle insertion, a payer or auditor may downcode to 10021 (palpation-guided FNA, lower payment). Prevention: ensure procedure note templates include a specific field or documentation prompt for imaging guidance confirmation. The note should state the modality used and that it was used to guide the needle, not merely to identify the target beforehand.

Denial: Invalid code (10022 submitted)

Claims submitted with deleted code 10022 will be rejected as invalid. Prevention: verify that all billing systems, encoders, and charge capture tools have been updated to remove 10022 and replace it with the appropriate code from the 10005-10012 family based on imaging modality. This should have been addressed in 2019 but occasionally surfaces in systems that were not fully updated or in practices newly onboarding staff trained on older materials.

Coding Scenarios

Scenario 1: A radiologist performs US-guided FNA on a 1.8 cm hypoechoic thyroid nodule with microcalcifications (ACR TIRADS 5) in an outpatient hospital imaging suite. Ultrasound guidance is documented as continuous and real-time during needle insertion. One lesion is biopsied. A pathologist is present for ROSE and performs two on-site adequacy assessments before the proceduralist is satisfied.

Correct coding: Proceduralist: 10005 with diagnosis D44.0. Pathologist: 88172 (first adequacy episode) + 88177 (second episode). Do NOT bill 76942.

Why: One lesion, ultrasound guided, first lesion in session = 10005. The pathologist's on-site work is separately reportable by the pathologist, not the proceduralist. The ROSE is two total episodes (one 88172 + one 88177), both within MUE limits.

Scenario 2: During the same session, a radiologist biopsies two separate enlarged cervical lymph nodes, both under continuous ultrasound guidance. Each node is documented as a distinct structure with separate biopsy passes.

Correct coding: 10005 (first lymph node) + 10006 (second lymph node) with diagnosis R59.0 or C77.0 if a primary malignancy is established.

Why: Both lesions use the same modality (ultrasound) in the same session. The first lesion = 10005; each subsequent lesion = 10006. Billing two units of 10005 would violate the MUE of 1 and result in denial of the second unit.

Scenario 3: A surgeon biopsies a palpable neck mass (no guidance used) and then, in the same session, biopsies a deep retroperitoneal lymph node using CT guidance.

Correct coding: 10021 (palpation-guided, first lesion) + 10009 with modifier -59 (CT-guided, different modality = separate first-lesion code). Do NOT use 10006, which is the add-on specific to the ultrasound-guided 10005 family.

Why: Different imaging modalities in the same session are each reported with their respective primary code. The CPT FNA guidelines explicitly permit reporting both primary codes when different modalities are used, provided modifier -59 is appended to the second primary code.

Scenario 4: A surgeon evaluates a patient with a new breast mass in the office, performs a separately documented and medically necessary E/M focused on the new finding, and immediately follows with US-guided FNA of the mass.

Correct coding: 10005 (FNA, US guided) + appropriate E/M code with modifier -25, diagnosis N63.11 (or confirmed malignancy code if known).

Why: The E/M is separately identifiable and documented beyond routine pre/post-procedural assessment. Modifier -25 on the E/M signals to the payer that it is distinct from the minor procedure. Without -25, the E/M will be bundled into the procedure and denied by most payers.

Related Codes

• 10006: FNA biopsy, ultrasound guidance, each additional lesion; required add-on when more than one lesion is biopsied with US guidance in the same session
• 10021: FNA biopsy, without imaging guidance, first lesion; primary alternative when no real-time imaging is used
• 10004: FNA biopsy, without imaging guidance, each additional lesion; add-on to 10021
• 10007: FNA biopsy, fluoroscopic guidance, first lesion; use when fluoroscopy guides the needle
• 10009: FNA biopsy, CT guidance, first lesion; use when CT guides the needle
• 76942: Ultrasonic guidance for needle placement, imaging S&I; bundled into 10005, do not report together
• 88172: Cytopathology, immediate cytohistologic study of FNA, first evaluation episode; billed by pathologist for on-site adequacy assessment
• 88173: Cytopathology, FNA interpretation and report; billed by interpreting pathologist for final diagnosis
• 88177: Cytopathology, FNA immediate cytohistologic adequacy, each additional episode; add-on to 88172

Sources

1. CPT Code 10005, Coding Ahead CPT Database, 2026-03-18 — Official description, status, MUE = 1, global days (XXX), PC/TC indicator = 0, bilateral indicator = 0, multiple procedures indicator = 2, code history (added 2019-01-01), ASC/APC payment indicators
2. CPT Code 10006, Coding Ahead CPT Database, 2026-03-18 — Add-on code description, MUE = 3, APC/ASC packaging (packaged, no separate ASC payment)
3. CPT Code 76942, Coding Ahead CPT Database, 2026-03-18 — Ultrasound guidance code; CPT parenthetical explicitly excludes from reporting with 10005
4. CPT Codebook Guidelines: Fine Needle Aspiration (FNA) Biopsy section, as extracted in Coding Ahead CPT Database, 2026-03-18 — Bundling rules, multi-lesion reporting rules, different-modality reporting rules, FNA vs core biopsy interaction rules
5. CPT Code 10022 (Deleted), Coding Ahead CPT Database, 2026-03-18 — Predecessor code history confirming deletion effective 2019-01-01; cross-reference to 10005-10012
6. CPT Codes 88172, 88173, 88177, Coding Ahead CPT Database, 2026-03-18 — Cytopathology codes, separately billable by pathologist, 2024 guideline changes noted