Fine needle aspiration; without imaging guidance

CPT 10021 is the billing code for "Fine needle aspiration; without imaging guidance". Fine needle aspiration biopsy without imaging guidance for diagnostic sampling

Medicare pays approximately $97.69 for CPT 10021 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.

CPT 10021 has a total RVU of 1.66, broken down as: Work RVU 0.75, Practice Expense RVU 0.85, and Malpractice RVU 0.06. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 10021 include: Location of lesion documented; Method of aspiration documented; Specimen obtained and sent for cytology; Patient tolerance documented. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 10021: Includes aspiration and specimen collection. Does not include imaging guidance Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 10021 include: 59 (Distinct procedural service when multiple procedures performed), 50 (Bilateral procedure), LT (Left side). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

The typical time requirement for CPT 10021 is Typically 15-30 minutes. Time-based codes require documentation of the actual time spent providing the service.