Coders working in radiology or urology may want to circle January 1, 2026, on their calendars. That’s when nine brand-new Category I CPT® codes, as well as one revised code for prostate biopsy services, are set to take effect. The American Medical Association (AMA) will release the official codes later this year, but an early preview from the American College of Radiology (ACR) paired with information provided in the FY 2026 Medicare Physician Fee Schedule (MPFS) Proposed Rule gives us enough to start preparing—and there’s plenty to prepare for.

So, What’s Changing with Prostate Biopsy Coding?

The nine new codes for prostate biopsy represent a significant expansion to prostate biopsy reporting. Historically, coders have had only three prostate biopsy codes to report these services.

Existing Code Updates

New Codes Effective January 1, 2026

Following is a list of the 9 new codes and their descriptors, as detailed in the FY 2026 MPFS Proposed Rule.

This expansion reflects the complexity of modern prostate cancer diagnostics. Rather than one-size-fits-all reporting, the code set now distinguishes between targeted vs. sextant biopsies, imaging modalities, and procedural approaches—all details that organizations will need to ensure are captured consistently in documentation.

These new distinctions matter—a lot. They reflect the complexity of modern prostate cancer diagnostics. Coding accuracy hinges on the ability to capture not just that a biopsy was performed, but how it was performed. As imaging techniques and procedures become more advanced, the CPT® code set must expand beyond the current “one-size-fits-all” reporting in order to capture the totality of services provided.

Don’t Wait for the Codes to be Finalized—Start Preparing Now

While the exact CPT® codes and descriptions won’t be officially finalized until September 2025, there’s no need to wait. Now’s the time to start educating providers and technologists on what documentation will be needed to support the changes. Encourage clear language in the procedure note about:

  • Biopsy approach and method (e.g. transperineal, transrectal, in-bore)
  • Whether the biopsy was targeted or sextant
  • Type of imaging used for guidance (ultrasound, MRI, MRI-ultrasound-fusion, CT)
  • Whether the imaging was pre-procedure, concurrent, or fusion-based

Even if you’re not working with prostate biopsy codes daily, chances are high they’ll show up in your coding workflow if you’re in a radiology group, hospital imaging center, or large urology practice.

Final Thought: This Isn’t Just a Code Swap

These updates reflect how prostate cancer diagnosis is changing. While sextant biopsy has long been the standard of care for men with suspected prostate cancer, there has been a shift within the past decade towards targeted image guided biopsy. This evolution impacts not only coding but also operations – affecting scheduling, equipment use, and provider training. Leaders should view the coding updates as part of a bigger picture: aligning coding and documentation accuracy with advances in clinical practice.

For coders, this means:

  • New learning curves
  • Deeper reads of the procedure note
  • More provider queries

For leaders, this means:

  • Supporting staff education early
  • Updating documentation templates
  • Ensuring alignment across compliance, revenue cycle, and clinical teams

Remember, it is never too early to begin provider and coder education with the information that has already been released. Until the AMA releases the official finalized codes and descriptions in the fall, stay curious—and as always, if it’s not documented, it didn’t happen.

Disclaimer: CPT® codes and descriptions are copyrighted 1995-2025 by the American Medical Association (AMA). All rights reserved.

 

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