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See a sample rate comparisonCPT 55100 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.
Drainage Of Genital Injury, Procedure To Drain A Deep Abscess Or Hematoma (Pocket Of Infection Or Blood) From The Penis Scrotum Testicles Or Other Part Of The Genitals.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Male Genital System |
| Common Place of Service | 23 - Emergency Room 21 - Inpatient Hospital |
| Common Modifiers | None AG - Primary physician 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 55100 |
| Medicaid Fee Schedule | View Medicaid rates for 55100 |
National average reimbursement for CPT 55100 by major payers:
$280.71
$297.03
$325.43
$376.42
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CPT 55100
5 of 25 sample ratesHigher to lower in this preview
St. Mary'S Surgical Center LLC, St. Mary'S Surgical Center
St Marys Surgical Center LLC
$2,912.00Published rateGulfshore Endoscopy Center LLC
$1,258.00Published ratePennsylvania Eye & Ear Surgery, PA Eye & Ear Surgery Center, LLC
Pennsylvania Eye Ear Surgery
$878.00Published rateNew Orleans La Uptown West Bank Endoscopy Asc LLC, Mga Gastrointestinal Diagnostic And Therapeutic Center
$517.00Published rateCorie Aiken
Deaconess Hospital Inc
$177.74Published rate
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See a sample payer proposalCPT 55100 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 55100 code is part of the Surgery services used for Surgical Procedures on the Male Genital System. 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 55100 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 |
|---|---|---|
| 55000-CPT | Low | Punctur Aspirat Of Hydrocele Tunica Vaginalis W//W/O In, Puncture Aspiration Of Hydrocele Tunica Vaginalis With Or Without In |
| 55040-CPT | Moderate | Excision Of Hydrocele; Unilateral |
| 55041-CPT | Moderate | Excision Hydrocele Bilateral |
| 55100-CPT | Moderate | Drainage Of Genital Injury, Procedure To Drain A Deep Abscess Or Hematoma (Pocket Of Infection Or Blood) From The Penis Scrotum Testicles Or Other Part Of The Genitals. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 55100. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 55100 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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