CPT 55700: Prostate biopsy
What this code means, what it should cost, and how to dispute an overcharge.
Fair Price Reference
What is CPT 55700?
CPT 55700 (Prostate biopsy) is a urology billing code defined by the American Medical Association. It's used to bill your insurance or you directly for this service.
What CPT 55700 should cost
The Centers for Medicare & Medicaid Services (CMS) pays approximately $179 for CPT 55700 under the 2025 Physician Fee Schedule. This is what the federal government has determined is a reasonable payment for this service.
Private insurance typically pays 1.2–1.8x Medicare rates ($215–$322). Hospital chargemaster prices for CPT 55700 often range from $350 to $1800 — a markup of 2x to 10.1x over Medicare.
Common overcharges on CPT 55700
Billing diagnostic cystoscopy (52000) and therapeutic cystoscopy (52353) for the same encounter. Billing lithotripsy codes multiple times when a single session was performed.
About Urology billing
Urological procedures often combine a diagnostic cystoscopy with a therapeutic intervention, creating coding complexity and opportunities for overbilling.
Request the procedure note. If one procedure was performed, only the most comprehensive code applies.
How to dispute a CPT 55700 overcharge
- Request the itemized bill. You are entitled to a detailed line-by-line bill showing every CPT code billed. Ask in writing.
- Compare to Medicare allowable. If the charge exceeds 150% of Medicare ($269), you have grounds to dispute.
- Request documentation. For E&M codes, ask for the visit note. For procedures, ask for the operative report. The documentation must justify the code billed.
- Send a formal dispute letter. Cite the specific discrepancy between the documentation and the code. Reference Medicare rates and NCCI edits where applicable.
- Follow up in writing. Give the provider 30 days to respond. If they don't, escalate to the state attorney general and insurance commissioner.
Got CPT 55700 on your bill?
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