CPT 55720 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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 79 - Unrelated procedure - postop period • 78 - Return to OR - related procedure |
| Complexity Level | Moderate |
| CMS | $441.53 Physician Fee Schedule |
National average reimbursement for CPT 55720 by major payers:
$594.78
$609.79
$622.81
$763.06
| 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 55720 | ||||||
United | 55720 | $875.00 | 1033113402 - NORTHWEST FLORIDA SURGICAL CENTER, LLC, NORTH FLORIDA SURGERY CENTER | 593081991 - (FL) NORTHWEST FLORIDA SURGICAL CENTER | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55720 | $2470.00 | 1649827973 - PARK NICOLLET METHODIST HOSPITAL, PARK NICOLLET SAME DAY SURGERY CENTER | 410132080 - (MN) PARK NICOLLET HEALTH SERVICES | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55720 | $3273.00 | 1487039517 - KC PAIN ASC, LLC | 464510621 - (MO) KC PAIN ASC LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55720 | $2353.00 | 1629559208 - ORTHOARIZONA SURGERY CENTER GILBERT, LLC, ORTHOARIZONA SURGERY CENTER GILBERT | 823624585 - (AZ) ORTHOARIZONA SURGERY CENTER GILBERT LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55720 | $1450.00 | 1225188808 - LOS ANGELES ENDOSCOPY CENTER, LOS ANGELES AMBULATORY SURGERY CENTER | 954775738 - (CA) LOS ANGELES ENDOSCOPY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55720 | $2717.00 | 1932164852 - MAY STREET SURGI CENTER, LLC, MAY STREET SURGI CENTER | 223777533 - (NJ) MAY STREET SURGI CENTER, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55720 | $6245.00 | 1295887727 - TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS | 751047527 - (TX) TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55720 | $2714.00 | 1437202249 - PACMED CLINICS | 562290878 - (WA) PACMED CLINICS | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55720 | $2198.00 | 1750491205 - ENT SURGERY CENTER OF ATLANTA,LLC | 200075229 - (GA) ENT SURGERY CENTER OF ATLANTALLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55720 | $475.00 | 1356311419 - RIVERSIDE AMBULATORY SURGERY CENTER LLC | 522233625 - (MD) RIVERSIDE AMBULATORY SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55720 | $928.00 | 1922070911 - FAYETTEVILLE ASC LLC, NORTH HILLS GASTROENTEROLOGY ENDOSCOPY CENTER | 621691451 - (AR) FAYETTEVILLE ASC LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55720 | $2388.00 | 1972092146 - SURGERY CENTRE OF SW FLORIDA LLC, FORT MYERS SURGERY CENTER | 454068750 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55720 | $2762.00 | 1992708929 - NOVAMED MANAGEMENT SERVICES LLC, ATLANTA EYE SURGERY CENTER | 364013255 - NOVAMED, INC. | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55720 | $5048.00 | 1003127606 - MEMORIAL HERMANN ENDOSCOPY CENTER NORTH FREEWAY LLC, MEMORIAL HERMANN ENDOSCOPY CENTER NORTH LOOP | 272800702 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55720 | $850.00 | 1407095359 - PAIN CARE CENTER OF GEORGIA LLC | 814348805 | GA | 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 55720 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 55720 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 55720 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 |
|---|---|---|
| 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 |
| 55720-CPT | Moderate | Prostatotomy W Drain Abscess Simpl |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 55720. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 55720 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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