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Renal masses are increasingly detected incidentally on abdominal imaging. Upon discovery, dedicated renal imaging, typically multiphasic computed tomography or MR imaging, is performed for characterization. Noninvasive risk-stratification systems, such as the Bosniak classification for cystic masses and the clear cell likelihood score for solid masses, continue to improve characterization. Despite these improvements in imaging, management dilemmas persist. These challenges arise from the limitations in specificity of imaging and the often indolent behavior of small renal masses. This review outlines the techniques of renal mass biopsy and discusses key clinical scenarios where biopsy findings inform management.