CPT Codes for Lymph Node Biopsy

Last Updated: 2026 | Coding framework aligned to AMA CPT® structure, CMS NCCI bundling policy, and common payer global-day assignments

Quick Reference

• FNA lymph node biopsy: CPT 10021 (without imaging) and modality-specific FNA codes (10005–10012) when imaging guidance is used; guidance is included in those codes and should not be billed separately.

• Core needle (percutaneous) biopsy: Superficial lymph node core is typically 38505; deep abdominal/retroperitoneal lymph node or mass core often uses 49180; imaging guidance codes (e.g., 76942, 77012) may be separately reportable when not bundled.

• Thoracic/mediastinal percutaneous core: CPT 32408 (introduced for percutaneous core lung/mediastinum biopsy) includes imaging guidance “when performed,” which affects separate guidance reporting.

• Open excisional biopsy: Codes in the 38500–38531 family depend on region and depth; “node(s)” generally means one code per incision/site even if multiple nodes are removed in that site.

• Sentinel lymph node biopsy (SLNB): Excision is coded using the appropriate open biopsy code (e.g., 38500/38525/38530/38531), and mapping may be reported with add-on 38900 when performed and supported by documentation.

• NCCI bundling hotspot: CMS NCCI policy generally prohibits reporting FNA and a core/open biopsy of the same lesion in the same encounter; bill only the more definitive procedure unless distinct lesions/sites are clearly documented.

Lymph node biopsy coding is primarily driven by technique (FNA vs. core needle vs. open excision), anatomic depth/location (superficial vs. deep; axillary vs. cervical vs. internal mammary vs. inguinofemoral), and workflow (single lesion vs. multiple lesions; same encounter repeats; sentinel node mapping). Correct CPT selection is only half the compliance picture: CMS NCCI edits and payer global-day rules frequently determine whether multiple biopsy methods can be reported together and whether modifiers are necessary.

This guide organizes lymph node biopsy coding into four operational buckets: (1) fine needle aspiration (FNA), (2) percutaneous core needle biopsy, (3) open excisional biopsy, and (4) sentinel lymph node biopsy (SLNB) with mapping. It also summarizes documentation requirements, common modifier patterns, global surgical periods, and bundling rules that drive denials if overlooked.

flowchart TD
    A[Lymph Node Biopsy] --> B{Technique?}
    B -->|Fine Needle Aspiration| C{Imaging guidance used?}
    C -->|No| D[**10021** first lesion<br>+10004 each additional]
    C -->|Yes - Ultrasound| E[**10005** first lesion<br>+10006 each additional]
    C -->|Yes - CT| F[**10009** first lesion<br>+10010 each additional]
    C -->|Yes - Fluoro| G[**10007** first lesion<br>+10008 each additional]
    B -->|Core Needle / Percutaneous| H{Location?}
    H -->|Superficial node| I[**38505**]
    H -->|Deep abdominal/retroperitoneal| J[**49180**]
    H -->|Thoracic/mediastinal| K[**32408**<br>includes imaging guidance]
    B -->|Open Excisional| L{Region & Depth?}
    L -->|Superficial cervical/axillary| M[**38500**]
    L -->|Deep cervical| N[**38510 / 38520**]
    L -->|Deep axillary| O[**38525**]
    L -->|Inguinofemoral deep| P[**38530 / 38531**]
    B -->|Sentinel Node SLNB| Q[Open biopsy code<br>+ **38900** mapping add-on]

Fine Needle Aspiration (FNA) Biopsy of Lymph Nodes

Definition and core CPT framework

FNA uses a thin needle to aspirate cells for cytology. Modern CPT coding for FNA is built around whether imaging guidance is used and (when imaging is used) which modality guided the needle. A key CPT concept is that FNA codes are per lesion, not per needle pass. Multiple passes into the same node are not multiple CPT units; they are part of completing one procedure on one lesion.

Common structures in the FNA family include:

• Without imaging guidance: CPT 10021 describes FNA without imaging for the first lesion. Documentation should identify the target node, laterality (if applicable), and a procedure description sufficient to support “FNA performed.”

• With imaging guidance: CPT created modality-specific primary codes for the first lesion and add-on codes for each additional lesion of the same modality. For example, ultrasound-guided FNA uses 10005 (first lesion) and +10006 (each additional), while CT-guided FNA uses 10009 (first lesion) and +10010 (each additional).

Critical rule: The modality-specific FNA codes include the imaging guidance in the code definition, so separate guidance billing is not appropriate when you report 10005–10012. This “guidance included” concept is a common denial driver when a claim inappropriately appends 76942 or 77012 to a modality-specific FNA line.

Multiple lesions and multiple modalities in the same session

Within a single session, only one unit of a given modality’s primary FNA code is generally expected (first lesion). Additional lesions of that modality are captured using the add-on code. If different lesions are performed under different modalities in the same session (for example one node under ultrasound and another under CT), then primary codes for each modality may be reportable because each primary code represents “first lesion” for that modality-specific workflow.

AMA instruction versus CMS NCCI bundling reality

Clinically, it is common to attempt FNA first and then escalate to core biopsy or open biopsy if FNA is non-diagnostic. The coding question is whether both can be billed when done on the same lesion in the same encounter. CMS NCCI policy is the controlling rule for Medicare claims and is widely followed by commercial payers: when an FNA is performed and then a more definitive biopsy is performed on the same lesion at the same encounter (because the FNA was inadequate or non-diagnostic), you typically report only the more definitive biopsy procedure.

However, if an FNA is performed on one node and a core or open biopsy is performed on a different node or different anatomic site in the same session, reporting both may be permissible with an appropriate distinct-procedure modifier and documentation that clearly distinguishes the lesions/sites. The practical compliance strategy is to write the procedure note as if a reviewer will not assume they were different: explicitly list node locations, laterality, and separate target descriptors.

Documentation essentials for FNA

• Target identification: Node station/region (e.g., “left level II cervical node,” “right axillary node”), depth if relevant, and laterality.

• Technique details: Needle gauge, number of passes, and specimen handling (e.g., slide prep, cell block) when documented by the operator.

• Imaging proof when applicable: When using imaging-guided FNA codes, document modality, target localization, and that permanent images or appropriate imaging documentation exist, consistent with CPT expectations.

• Global day context: FNA is generally treated as a minor procedure; same-day E/M requires modifier 25 only if significant and separately identifiable (payer-specific rules apply).

Core Needle (Percutaneous) Lymph Node Biopsy

Definition and why the code family changes

Core needle biopsy uses a larger bore device to obtain tissue cores, preserving architecture for histology (often needed when lymphoma is suspected). Unlike FNA, core biopsy coding is more anatomic: superficial node core is coded differently than deep abdominal or mediastinal targets, and imaging guidance is often separately reportable unless the biopsy code includes it.

Common CPT choices by region

• Superficial node core (percutaneous): CPT 38505 (biopsy or excision of lymph node(s); by needle, superficial) is commonly used for cervical, axillary, and inguinal superficial nodes when performed via needle rather than open incision.

• Deep abdominal/retroperitoneal node or mass core: CPT 49180 is widely used for percutaneous needle biopsy of an abdominal or retroperitoneal mass, including situations where the target is a deep lymph node or nodal mass in that region.

• Lung/mediastinum percutaneous core: CPT 32408 describes percutaneous core needle biopsy of the lung or mediastinum and includes imaging guidance “when performed,” which affects whether separate guidance codes should be added.

Imaging guidance coding (when not included)

When guidance is not bundled into the biopsy code, the guidance code is typically separately reportable if documentation supports it (including permanent image capture and a description of guidance). Ultrasound guidance (76942) is common for superficial nodes; CT guidance (77012) is common for deep abdominal or mediastinal targets. In facility settings, clinicians often report the professional component with modifier 26 on the guidance line. The key compliance issue is to avoid adding guidance when the primary biopsy code already includes it (notably 32408), and to avoid adding guidance to modality-specific FNA codes that already include guidance.

Units of service and distinct-site logic

For core biopsies, coding is generally one unit per distinct biopsy site/lesion approached. Multiple cores taken from a single needle placement into one node typically remain one procedure. If multiple lymph node regions are sampled (e.g., cervical and inguinal) in one encounter, separate biopsy codes may be reportable with distinct-procedure modifiers, and separate guidance units may be reportable if the guidance was performed for distinct lesions and the guidance code is defined per lesion.

Open Excisional Lymph Node Biopsy (Surgical)

What “open biopsy” means in CPT terms

Open lymph node biopsy involves an incision to remove one or more lymph nodes (or a portion) for pathology. CPT differentiates open biopsies by region and depth. A recurring CPT principle is that the descriptor “node(s)” does not grant multiple units for multiple nodes removed through the same incision in the same anatomic region. Instead, it reflects that removal of multiple nodes in that operative field is included in the single code when performed as part of the same open approach.

High-frequency open biopsy codes

In practice, the “deep vs superficial” decision is documentation-dependent. A surgeon’s note should describe the depth/planes and the node basin. For example, axillary nodes accessed with deeper dissection into axillary contents generally align better to a deep axillary code than a superficial open biopsy. Conversely, a small superficial palpable node removed in the office or minor procedure suite typically aligns to 38500 when done as an open excision.

Global surgical periods and postoperative bundling

Open biopsy codes are not all treated the same under payer global-day assignments. Many payers and Medicare commonly assign shorter global periods to simpler open biopsies and 90-day globals to more extensive open node procedures. Because global-day policies can vary by payer and can be updated, coders frequently cross-check global-day assignments when planning staged procedures or billing postoperative returns.

Sentinel Lymph Node Biopsy Procedures (SLNB)

Core concepts: excision code plus mapping code

SLNB is a specialized lymph node biopsy performed for staging in cancers such as breast cancer, melanoma, and gynecologic malignancies. The workflow includes (1) mapping/identification using tracer and/or dye and (2) surgical excision of the sentinel node(s). Coding generally reflects that structure: the excision is billed using the appropriate open lymph node biopsy code for the basin (e.g., axillary, cervical, internal mammary, inguinofemoral), and the mapping work may be captured using add-on 38900 when performed and documented.

CMS guidance for sentinel lymph node biopsy coding emphasizes using the correct open biopsy family for the excision component rather than billing a lymphadenectomy code for a limited sentinel sampling. This distinction matters because lymphadenectomy codes (e.g., complete axillary dissections) represent removal of an entire nodal basin and carry different valuation and bundling logic under NCCI policy.

38900 and 38792: avoiding duplicate injection/mapping billing

CPT 38900 is typically used for intraoperative sentinel node identification/mapping and is reported as an add-on to the primary procedure when the mapping work is done by the surgeon in the operative setting. CPT 38792 is associated with injection of radioactive tracer for sentinel node identification and may be used in some preoperative nuclear medicine workflows. CMS bundling logic can restrict billing both codes for the same day/episode if they represent duplicative mapping services; the operational compliance approach is to ensure each code represents a distinct service performed by distinct providers (preoperative radiotracer injection vs intraoperative mapping) and to follow payer-specific edit behavior.

Sentinel biopsy plus full dissection in the same basin

NCCI policy addresses a common intraoperative reality: a sentinel node is identified and excised, then the case converts to a complete dissection of the same basin. In that setting, CMS policy generally treats the limited biopsy as included in the more extensive dissection for that basin, and only the definitive dissection is reported. However, mapping work may still be separately reportable when performed, because mapping is not automatically “erased” by conversion, provided documentation supports it and payer edits allow it.

Modifier Use, Global Days, and NCCI Bundling

Distinct lesion/site modifiers (59 and X-modifiers)

When reporting multiple biopsy services on the same date, the major question is whether they were performed on the same lesion or different lesions/sites. NCCI policy drives this analysis. If procedures are distinct (different node basins, different lesions, different incisions), a distinct-service modifier such as 59 (or a payer-preferred X-modifier like XS for separate structure) may be needed to pass claim edits.

The highest-risk combination is FNA plus core/open biopsy. Under NCCI policy, an FNA and core/open biopsy of the same node at the same encounter should not both be reported; the claim should reflect the definitive procedure. If both are performed on different nodes, the documentation should make that separation explicit and the claim should use an appropriate distinct-procedure modifier.

Laterality and bilateral reporting

When biopsies are performed bilaterally (e.g., left and right axillary nodes), reporting may use modifier 50 or two line items with LT/RT, depending on payer preference. The coding decision is not purely technical: payer adjudication systems vary, and facilities often standardize on one approach for predictability. For procedures in the 385xx family, many payers enforce unit limits (often one unit per side), so clear laterality documentation is essential for payment.

Global surgical period strategy (58, 78, 79)

Global-day rules matter when a diagnostic biopsy is followed by a planned definitive procedure (for example, a later lymphadenectomy or tumor resection) or when postoperative complications require return to the OR. Payers often publish global day assignments; one commonly referenced source is UnitedHealthcare’s global day assignment policy document. In staged/related procedures within the global, modifier 58 may be relevant; for an unplanned return to the OR for complications, modifier 78 may apply; and for unrelated procedures during the global, modifier 79 is used. Correct modifier selection depends on operative timing, relatedness, and whether the subsequent procedure is planned or emergent.

Imaging guidance component billing (26/TC)

Component modifiers typically apply to guidance codes rather than the surgical biopsy codes themselves. In hospital/ASC settings, the professional component is frequently billed with modifier 26 by the physician while the facility bills the technical component (or the technical is included in facility billing), depending on contractual and site-of-service rules. The central compliance rule remains: do not bill separate guidance when guidance is included in the primary procedure code (e.g., 32408 includes imaging guidance when performed; modality-specific FNA codes include guidance).

Practical Coding Scenarios

Scenario 1: Ultrasound-guided FNA of a single cervical node

Work performed: One lymph node targeted under ultrasound guidance; multiple passes obtained for cytology.

Code concept: Report the ultrasound-guided FNA primary code for the first lesion (e.g., 10005) and do not separately report ultrasound guidance, because guidance is included in the FNA code definition.

Documentation focus: Node location/level, laterality, ultrasound localization, and that images/documentation exist.

Scenario 2: Core biopsy of a superficial axillary node with ultrasound guidance

Work performed: Percutaneous core biopsy of a superficial axillary node using ultrasound guidance.

Code concept: 38505 for superficial needle biopsy plus ultrasound guidance code (commonly 76942) if not bundled and if documentation supports saved images/needle guidance requirements.

Component note: In a facility, the physician may bill the professional component of guidance with modifier 26.

Scenario 3: FNA attempted, then core biopsy performed on the same node (same encounter)

Work performed: FNA yields inadequate specimen; operator proceeds to core biopsy of the same lymph node in the same session.

Code concept: Under CMS NCCI policy, do not report both procedures for the same lesion at the same encounter; report only the more definitive biopsy (the core biopsy).

Documentation focus: Explicit statement that FNA was non-diagnostic/inadequate and that core biopsy was performed on the same lesion.

Scenario 4: Percutaneous mediastinal core biopsy

Work performed: Percutaneous core biopsy of a mediastinal target with imaging guidance used to place the needle.

Code concept: CPT 32408 captures percutaneous core biopsy of lung/mediastinum and includes imaging guidance when performed, reducing or eliminating the need to separately report guidance depending on the circumstances and payer edits.

Scenario 5: Sentinel lymph node biopsy in the groin with mapping

Work performed: Sentinel node mapping and excision in the inguinofemoral region (e.g., vulvar cancer staging).

Code concept: Use 38531 for the inguinofemoral sentinel node excision (when that best matches the approach) and add-on 38900 for intraoperative sentinel node identification/mapping when performed and documented.

Bundling caution: If a complete inguinofemoral dissection is performed in the same basin, the limited biopsy component is generally not separately reported under NCCI principles.

Bottom line: Choose the biopsy code that matches the technique and anatomy, then apply payer-driven rules (NCCI bundling, component billing, global period modifiers) to decide whether additional lines, guidance codes, or modifiers are valid. When denials occur, the first troubleshooting step is usually to determine whether the denial is driven by (1) included guidance, (2) prohibited “FNA + core/open on same lesion” billing, (3) insufficient distinct-site documentation, or (4) global period conflicts.

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