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Wiki New prostate biopsy CPT codes

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Katyatbeach

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I work for a Urology practice in Georgia and our part B Medicare is denying the CPT code 55707 for POS 11. Is anyone else having this issue? This has to be an error on Medicare's part but I am unable to find any documents that address this issue.
 
CPT 55707 should be payable in POS 11 (Office), so widespread denials often indicate payer system edits that haven't been updated for the new 2026 prostate biopsy codes.
the Medicare Physician Fee Schedule shows non-facility RVUs/payment for 55707, which confirms that CMS expects the procedure to be billed in an office setting as well
invalid for POS 11 usually points to a claims processing edit error
 
Please provide if anyone has had any updates regarding this, as of today Medicare is still denying for POS - Has anyone tried an Redetermination and the outcome.
 
Katyatbeach said:
Great News! Per my billing department they started paying on these end of February begin of March!!! So, rebill the ones that did not get paid
Click to expand...
Our appeals from last month came back denied today saying that medicare doesnt provide POS indication so it falls to your local contractor. I would love to think that we can refile but after the appeal was denied literally came back electronically today I am skeptical
 
Katyatbeach said:
I work for a Urology practice in Georgia and our part B Medicare is denying the CPT code 55707 for POS 11. Is anyone else having this issue? This has to be an error on Medicare's part but I am unable to find any documents that address this issue.
Click to expand...
Hi Everyone, :)
Ahh biopsy of rectal area to get to prostate...in the office?:oops:o_O That seems too invasive done in doc office. I think should be in facility or Ambulatory .Well hope the dx is not unspec dx blocks of N42 or N52 maybe another reason not paying and 2nd dx. could be Z12.5
I hope this data helps you:)(y)
Lady T
 
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