CPT 55500 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Male Genital System |
| Common Place of Service | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 55500 |
National average reimbursement for CPT 55500 by major payers:
$554.00
$518.77
$559.75
$655.92
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 55500 | ||||||
United | 55500 | $1750.00 | 1104465012 - EVERGREEN EYE CENTER, PLLC | 911628032 - (WA) EVERGREEN EYE CENTER, INC. P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55500 | $3864.00 | 1063720365 - WASATCH FRONT SURGERY CENTER LLC | 800612279 | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55500 | $591.00 | 1720495708 - TRI-CITY ORTHOPAEDIC CLINIC P S C, THE SURGERY CENTER AT TCO (KENNEWICK) | 911866685 - (WA) TRI-CITY ORTHOPAEDIC CLINIC, PSC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55500 | $3570.00 | 1396919783 - SURGCENTER OF SOUTHERN MARYLAND, LLC | 261572885 - (MD) SURGCENTER OF SOUTHERN MARYLAND | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55500 | $588.00 | 1083299747 - IRVING SPECIALISTS SURGICAL CENTER LLC | 852271899 - (TX) IRVING SPECIALISTS SURGICAL CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55500 | $3305.00 | 1982238465 - PROFESSIONAL RECREATION ORGANIZATION, INC. | 931484998 - (WA) PRO SURGERY CENTER LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55500 | $1546.00 | 1780865634 - NEW ORLEANS LA UPTOWN WEST BANK ENDOSCOPY ASC LLC, MGA GASTROINTESTINAL DIAGNOSTIC AND TERAPEUTIC CENTER | 205904604 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55500 | $1685.00 | 1831238773 - CORPUS CHRISTI ENDOSCOPY CENTER LLP, CORPUS CHRISTI ENDOSCOPY CENTER | 202595593 - (TX) CORPUS CHRISTI ENDOSCOPY CENTER LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55500 | $4339.00 | 1083938765 - MEDICAL PARK TOWER SURGERY CENTER, LLC, MEDICAL PARK TOWER SURGERY CENTER | 270543475 - (TX) MEDICAL PARK TOWER SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55500 | $588.00 | 1750582797 - BAY AREA LASER SURGERY CENTER, A MEDICAL CORPORATION | 208712646 - (CA) BAY AREA LASER SURGERY CENTER A MEDICAL CORPORATION | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55500 | $753.00 | 1285736207 - PODIATRY GROUP OF ANNAPOLIS AMBULATORY SURGICAL CENTER, PODIATRY GROUP OF ANNAPOLIS AMBULATORY SURGICAL CENTER LLC | 522197193 - (MD) PODIATRY GROUP OF ANNAPOLIS AMBULATORY SURGICAL CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55500 | $4140.00 | 1578530226 - PHYSICIANS SURGICAL CENTER OF FT. WORTH LLP, BAYLOR SCOTT & WHITE SURGICARE FORT WORTH | 208303422 - (TX) PHYSICIANS SURGICAL CENTER OF FT WORTH LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55500 | $1099.00 | 1700881539 - ARTURO BETANCOURT, M.D., P.A., BALTIMORE WASHINGTON EYE CENTER | 522032553 - (MD) ARTURO BETANCOURT, MD, PA | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55500 | $591.00 | 1104087089 - CONGRESS MEDICAL SURGERY CENTER LLC | 262785454 - (CA) CONGRESS MEDICAL SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55500 | $1623.00 | 1922016898 - JAMES TRICE MD PA, DIGESTIVE DISEASE CENTER | 710758882 | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 55500 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 55500 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 55500 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 |
|---|---|---|
| 55400-CPT | Moderate | Vasovasostomy Unilateral |
| 55500-CPT | Moderate | Excis.Of Hydrocele Of Spermatic Cord,Uni |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 55500. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 55500 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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