What is CPT Code 10005?

CPT Code 10005 is a medical billing code used by healthcare providers to document and receive reimbursement for a Fine Needle Aspiration Biopsy Including Ultrasound Guidance; First Lesion. It typically involves moderate-level medical decision-making.

What factors affect the fee schedule for CPT 10005?

Several factors influence the fee schedule for CPT 10005, including Medicare & Medicaid rates (government-set), Private Insurance rates (negotiated between providers and insurers), Geographic Location (costs higher in urban areas), and Provider Type (hospital vs. private practice).

What is the full description of CPT 10005?

CPT 10005 describes a "Fine Needle Aspiration Biopsy Including Ultrasound Guidance; First Lesion." It's generally classified under Surgery, specifically General Surgical Procedures.

How does CPT 10005 compare to other general surgical procedure codes?

CPT 10005 is part of a series of General Surgical Procedure codes. It represents a moderate-complexity encounter, requiring more provider time and medical decision-making compared to lower-level codes. This typically leads to higher reimbursement and more detailed documentation.

Where can I view Medicare rates for CPT 10005?

You can view Medicare rates for CPT 10005 on the PayerPrice platform, specifically through their Medicare fee schedule lookup tool for 2025 data.

CPT stands for Current Procedural Terminology. CPT codes are a set of medical codes used by healthcare providers, payers, and government agencies to describe medical, surgical, and diagnostic services. They are crucial for accurate billing, processing of medical claims, and tracking healthcare utilization.

How can I find the cost of a specific medical procedure?

Finding the exact cost of a medical procedure can be complex due to varying factors like your insurance plan, location, provider, and specific services rendered. To get an estimate, you can look up fee schedules. For precise and up-to-date pricing information based on CPT codes and your specific location, you should use a dedicated fee schedule lookup tool. Payerprice offers such a tool where you can search with a CPT code and location to find relevant fee schedules and understand potential costs.

What is a fee schedule in healthcare?

A fee schedule is a comprehensive listing of fees used by insurance companies and other payers to reimburse doctors or other healthcare providers. It specifies the maximum amount that will be paid for each CPT (Current Procedural Terminology) code or service. These schedules can vary significantly by payer, geographic location, and even individual provider agreements, playing a critical role in determining healthcare costs.

Why do medical costs vary so much for the same procedure?

Medical costs vary widely due to several factors, including geographic location, the specific healthcare provider or facility, the patient's insurance coverage (or lack thereof), the complexity of the procedure, and variations in negotiated rates between providers and insurance companies. Different payers also have different fee schedules, contributing to the cost disparities.

Where can I find specific fee schedules for my location and a particular CPT code?

To find specific fee schedules tailored to your location and the services you need, you should utilize a specialized online tool. Payerprice provides a fee schedule lookup tool where you can input the CPT code for the service and your specific location to find relevant pricing information. This offers a more precise way to understand potential costs than general information sources.

What information do I need to use a fee schedule lookup tool effectively?

To use a fee schedule lookup tool effectively, you typically need the CPT (Current Procedural Terminology) code for the specific medical procedure or service you are interested in, and your specific geographic location (e.g., zip code or state). Tools like Payerprice's fee schedule lookup can then use this information to provide relevant pricing data.

CPT 10005 Fee Schedule

Last Verified: October 2026

Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.

Obtain Tissue Through A Needle, Biopsy In Which A Thin Hollow Needle Is Inserted Through The Skin Guided By Ultrasound Into A Mass Or Fluid To Collect A Sample.

Key Fact	Detail
Service Type	Surgery General Surgical Procedures
Common Place of Service	11 - Office 22 - On Campus Outpatient Hospital
Common Modifiers	None RT - Right side of body LT - Left side of body
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 10005
Medicaid Fee Schedule	View Medicaid rates for 10005

National average reimbursement for CPT 10005 by major payers:

$161.61

$167.58

$170.01

$134.58

Compare published rates across providers.

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CPT 10005

5 of 25 sample ratesHigher to lower in this preview

Matthew Lilley
Bend Memorial Clinic, PC
OROrthopaedic Surgery PhysicianNPI 1003166612Tax ID 68-0637976
$372.88Published rate
Edward Moore
Deaconess Hospital Inc
INInterventional Cardiology PhysicianNPI 1578527263Tax ID 35-0593390
$222.44Published rate
Jorge Nieves
Allied Physicians Group PLLC
NYPediatrics PhysicianNPI 1427192921Tax ID 20-4762421
$190.08Published rate
Tsai Chao
Naturomedical Health Care PC
NYPhysical Medicine & Rehabilitation PhysicianNPI 1609850668Tax ID 13-3668362
$139.50Published rate
Relly Chern
NYOphthalmology PhysicianNPI 1568472645Tax ID 13-3101496
$67.06Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

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CPT 10005 vs. Other General Surgical Procedures Codes

The CPT 10005 code is part of the Surgery services used for General Surgical Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The CPT 10005 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

Code	Complexity	Description
10004-CPT	Low	Fine Needle Aspiration Biopsy, Fine Needle Aspiration Biopsy Without Imaging Guidance Each Additional Lesion (List Separately In Addition To Code For Primary Procedure)
10005-CPT	Low	Obtain Tissue Through A Needle, Biopsy In Which A Thin Hollow Needle Is Inserted Through The Skin Guided By Ultrasound Into A Mass Or Fluid To Collect A Sample.
10006-CPT	Low	Fine Needle Aspiration Biopsy, Fine Needle Aspiration Biopsy Including Ultrasound Guidance Each Additional Lesion (List Separately In Addition To Code For Primary Procedure)
10007-CPT	Moderate	Sample Tissue Using A Needle, Removal Of Body Fluid Or Tissue By Aspiration (Suction) Using A Fine Needle.

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 10005. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 10005 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules

Medicare & Medicaid Rates

Government-set reimbursement amounts

Private Insurance Rates

Negotiated rates between providers and insurance companies

Geographic Location

Costs may be higher in urban areas.

Provider Type

Hospital providers may have different rates than private practice.

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CPT 10005 Fee Schedule

Compare published rates across providers.

Matthew Lilley

Edward Moore

Jorge Nieves

Tsai Chao

Relly Chern