CPT 55680 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 21 - Inpatient Hospital |
| Common Modifiers | None LT - Left side of body 59 - Distinct Procedural Service 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 55680 |
National average reimbursement for CPT 55680 by major payers:
$467.08
$462.89
$478.84
$574.57
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 55680 | $1150.00 | 1093760019 - OCEAN COUNTY EYE ASSOCIATES LLC, OCEAN COUNTY EYE SURGERY CENTER | 223256927 - (NJ) OCEAN COUNTY EYE ASSOCIATES, P.C. | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55680 | $3871.00 | 1649233180 - WEST PARK SURGERY CENTER, L.P., MEDICAL CITY SURGERY CENTER/MCKINNEY | 800002697 - (TX) WEST PARK SURGERY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55680 | $1028.00 | 1659408300 - CENTRE AVENUE GROUP, LLC, EAST SIDE SURGERY CENTER | 202831701 - (PA) CENTRE AVENUE GROUP, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55680 | $5402.00 | 1700431798 - METHODIST AMBULATORY SURGERY CENTER OF BOERNE, LLC | 823532569 - (TX) METHODIST AMBULATORY SURGERY CENTER OF BOERNE LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55680 | $1224.00 | 1851317614 - KENDALL POINTE SURGERY CENTER LLC | 364236445 - (IL) KENDALL POINTE SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55680 | $2169.00 | 1700419678 - METHODIST MANSFIELD AMBULATORY SURGERY CENTER, LLC | 260869371 - (TX) METHODIST MANSFIELD AMBULATORY SURGERY CENTER LL | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55680 | $960.00 | 1770645905 - SILVER SPRING MD ENDOSCOPY ASC LLC, ENDOSCOPIC SURGICAL CENTRE OF MARYLAND | 205988845 - (MD) SILVER SPRING MD ENDOSCOPY ASC LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55680 | $2307.00 | 1801146535 - SURGCENTER AT PARADISE VALLEY, LLC, SURGCENTER AT PIMA CROSSING | 455364868 - (AZ) SURGCENTER AT PARADISE VALLEY | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55680 | $2595.00 | 1669446852 - VOORHEES NJ ENDOSCOPY ASC LLC, THE ENDO CENTER AT VOORHEES | 510446274 - (NJ) THE VOORHEES NJ ENDOSCOPY ASC LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55680 | $1015.00 | 1538122684 - KISSIMMEE SURGICARE LTD | 752407306 - (FL) KISSIMMEE SURGICARE LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55680 | $4588.00 | 1326286360 - NORTH CAMPUS SURGERY CENTER LLC | 352147088 - (IN) NORTH CAMPUS SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55680 | $2388.00 | 1558753095 - PACIFIC ENDOSCOPY CENTER LLC | 203905706 - (HI) PACIFIC ENDOSCOPY CENTER, LLC | HI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55680 | $1232.00 | 1083780662 - PLASTIC SURGICENTRE, INC, THE PLASTIC SURGICENTRE, INC | 911473281 - (WA) THE PLASTIC SURGICENTRE, INC. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55680 | $1838.00 | 1093595696 - NEW LEXINGTON CLINIC PSC, DERMATOLOGY ASSOCIATES OF KENTUCKY PSC | 611262927 - (KY) NEW LEXINGTON CLINIC, P.S.C. | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55680 | $3174.00 | 1205030731 - PIERCE STREET SAME DAY SURGERY, LC, PIERCE STREET SAME DAY SURGERY, LC | 205895205 - (IA) PIERCE STREET SAME DAY SURGERY | IA | 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 55680 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 55680 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 55680 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 |
|---|---|---|
| 55520-CPT | Moderate | Remove Tissue From Testicle, Surgery To Remove Abnormal Or Injured Tissue From The Spermatic Cord A Part Of The Structure Of The Testicles. |
| 55530-CPT | Moderate | Surgery On Testicle Veins, Surgery To Remove An Abnormally Enlarged Portion Of One Or More Veins Inside A Testicle. The Procedure May Be Done At The Same Time As A Hernia Repair. |
| 55550-CPT | Moderate | Surgery On Testicle Veins, Surgery To Remove An Abnormally Enlarged Portion Of One Or More Veins Inside A Testicle. The Procedure May Be Done At The Same Time As A Hernia Repair. |
| 55680-CPT | Moderate | Remove Genital Cyst, Surgery To Remove A Pocket Of Fluid (Cyst) From The Duct Located Near The Seminal Vesicles (Paired Glands That Produce Fluid For Semen). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 55680. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 55680 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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