CPT 55700 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 | • 11 - Office • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • SG - Scene to Hospital ESRD facility • 22 - Increased Procedural Services |
| Complexity Level | Moderate |
National average reimbursement for CPT 55700 by major payers:
$276.06
$314.96
$346.47
$398.29
| 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 55700 | ||||||
United | 55700 | $1579.00 | 1689666596 - MENOMONEE FALLS AMBULATORY SURGERY CENTER, LLC | 391745697 - (WI) MENOMONEE FALLS AMBULATORY SURGERY CENTER | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55700 | $901.00 | 1275507527 - ENDOSCOPY CENTER OF NORTHWEST CONNECTICUT | 61609993 - (CT) ENDOSCOPY CENTER OF NORTHWEST CT | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55700 | $355.00 | 1437274495 - EYE SURGICAL CENTER OF SAN FRANCISCO LLC, EYE SURGERY CENTER OF SAN FRANCISCO | 203822864 - (CA) EYE SURGERY CENTER OF SAN FRANCISCO | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55700 | $750.00 | 1801811443 - PHYSICIANS OF WINTER HAVEN LLC, DAY SURGERY CENTER | 200324393 - (FL) PHYSICIANS OF WINTER HAVEN, LLC DBA DAY | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55700 | $5250.00 | 1275596264 - CAROLINA REGIONAL SURGERY CENTER. LTD | 621616402 - (SC) CAROLINA REGIONAL SURGERY CENTER LTD | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55700 | $440.04 | 1104445782 - EKATERINA GOOD | 350593390 - DEACONESS HOSPITAL INC | IL | Hospitalist Physician (208M00000X) |
United | 55700 | $440.04 | 1922036805 - DEACONESS HOSPITAL, INC, <UNAVAIL> | 350593390 - DEACONESS HOSPITAL INC | IN | Emergency Medicine Physician (207P00000X) |
United | 55700 | $400.00 | 1558328518 - BUTLER AMBULATORY SURGERY CENTER L L C | 61728190 - (PA) BUTLER AMBULATORY SURGERY CENTER, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55700 | $1025.00 | 1235692120 - LIBERTY CORNER SURGICAL CENTER AT MARLTON LLC | 833889870 - (NJ) LIBERTY CORNER SURGICAL CENTER AT MARLTON LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55700 | $330.00 | 1245575919 - MEMORIALCARE SURGICAL CENTER AT SADDLEBACK LLC, MEMORIALCARE SURGICAL CENTER LAGUNA WOODS | 203678259 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55700 | $496.00 | 1366635609 - APPLE SURGERY CENTER, INC | 260423287 - (CA) APPLE SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55700 | $496.00 | 1255309803 - G S S C LTD PARTNERSHIP | 680343818 - (CA) GSSC LTD PARTNERSHIP DBA GREATER SACRAMENTO SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55700 | $425.00 | 1609399963 - INTERVENTIONAL SURGERY INSTITUTE OF WHITE HALL LLC | 814296629 - (AR) INTERVENTIONAL SURGERY INSTITUTE OF WHITE HALL LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55700 | $360.00 | 1306486634 - FREDERICKSBURG ENDOSCOPY CENTER, LLC | 834398314 - (VA) FREDERICKSBURG ENDOSCOPY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55700 | $800.00 | 1811962103 - SALEM OR OPHTHALMOLOGY ASC LLC, SALEM LASER & SURGERY CENTER | 203802500 - (OR) SALEM OR OPHTHALMOLOGY ASC LLC | OR | 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 55700 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 55700 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 55700 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 |
|---|---|---|
| 55650-CPT | Moderate | Vesiculectomy, Any Approach |
| 55700-CPT | Moderate | Biopsy Prostate Needle/Punch |
| 55705-CPT | Moderate | Bx,Prostate;Incisional,Any Approach |
| 55706-CPT | Moderate | Once Per Dos Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling -Rn Review >=7/1/2018; Deny Inv/N10=5/8/2010-6/30/2018 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 55700. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 55700 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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