How much does Medicare pay for CPT 55706?

Medicare allowed an average of $669.08 per service and paid $528.65 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $2417.82, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 55706?

Needle biopsy of prostate gland using image guidance. It was billed 5,100 times to 5,083 Medicare beneficiaries by 195 providers in 2024.

Does 55706 pay differently in an office than a hospital?

Yes. The allowed amount averaged $396.56 in an office setting and $698.50 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 55706 most?

Urology, with 3,736 services from 155 clinicians. Next are Ambulatory Surgical Center, Radiation Oncology, Physician Assistant.

CPT 55706

Needle biopsy of prostate gland using image guidance

$669.08Medicare-allowed amount per service, averaged across 5,100 services

Providers submitted

$2417.82

Asking price, not received

Medicare allowed

$669.08

The fee schedule figure

Medicare paid

$528.65

Balance is patient coinsurance

Providers submitted an average of $2417.82 for this code and Medicare allowed $669.08 — 3.6× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $528.65 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $396.56
Hospital / facility: $698.50

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 497 services were billed in an office setting and 4,603 in a facility.

Services: 5,100
Beneficiaries: 5,083
Providers billing it: 195
Total allowed: $3,412,308

What Medicare pays for CPT 55706

Across 5,100 services billed by 195 providers to 5,083 beneficiaries, Medicare allowed an average of $669.08 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 55706

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	3,736	3,725	$376.97	155
Ambulatory Surgical Center	1,282	1,277	$1543.59	36
Radiation Oncology	64	63	$375.11	3
Physician Assistant	18	18	$59.81	1

55706 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Texas	663	$535.30	$439.61	25
Florida	629	$922.64	$768.38	27
New York	417	$478.70	$331.18	17
Arkansas	328	$905.11	$785.26	5
New Jersey	312	$409.15	$292.26	12
California	270	$636.12	$458.84	9
Washington	251	$925.00	$698.88	7
Maryland	249	$975.86	$805.53	5
Nevada	190	$764.64	$614.67	6
Oregon	139	$1142.37	$862.47	2
North Carolina	126	$355.85	$285.04	6
Michigan	124	$372.93	$289.59	5
Indiana	121	$343.65	$278.15	4
Missouri	111	$359.51	$277.50	7
Connecticut	105	$601.27	$449.09	6
Ohio	100	$354.23	$290.54	5
Georgia	98	$684.94	$566.16	7
Virginia	94	$363.79	$287.10	4
Illinois	82	$380.03	$276.84	4
South Dakota	72	$350.89	$287.99	3
Pennsylvania	72	$1400.05	$1124.87	2
Rhode Island	67	$719.40	$584.20	3
West Virginia	61	$364.59	$296.07	4
District of Columbia	59	$412.21	$291.81	2
South Carolina	54	$663.30	$545.18	3
Massachusetts	49	$870.97	$691.19	3
Kentucky	44	$1503.82	$1256.35	1
Tennessee	43	$780.52	$657.53	3
Wisconsin	37	$355.60	$286.78	1
Louisiana	37	$339.83	$286.47	2
Colorado	37	$377.73	$293.85	2
Arizona	37	$824.92	$661.28	2
Alabama	22	$1319.87	$1257.76	1

Related codes

55700Biopsy of prostate gland$311.10

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.