CPT 55725 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 • 11 - Office |
| Common Modifiers | • None • GC - Service performed by resident under supervision • 58 - Staged or related procedure during postoperative period • 59 - Distinct Procedural Service • 51 - Multiple procedures • 78 - Return to OR - related procedure |
| Complexity Level | Moderate |
| CMS | $582.88 Physician Fee Schedule |
National average reimbursement for CPT 55725 by major payers:
$752.04
$789.74
$818.34
$997.78
| 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 55725 | ||||||
United | 55725 | $1682.00 | 1902472715 - CENTRAL ARKANSAS RADIATION THERAPY INSTITUTE INC, CARTI SURGERY CENTER | 710437657 - (AR) CENTRAL ARKANSAS RADIATION THERAPY INSTITUTE INC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55725 | $2725.00 | 1902877509 - CULPEPER SURGERY CENTER LLC | 541975624 - (VA) CULPEPER SURGERY CENTER, LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55725 | $2307.00 | 1215548524 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55725 | $1485.00 | 1588071575 - FOULK ROAD SURGERY CENTER | 510385184 - (DE) WILMINGTON AMBULATORY SURGICAL CENTER LLC | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55725 | $3746.00 | 1699738112 - NORTH AUSTIN SURGERY CENTER, L.P. | 200648730 - (TX) NORTH AUSTIN SURGERY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55725 | $2007.00 | 1003332883 - DESERT VISTA SURGICAL CENTER LLC | 821195281 - (AZ) DESERT VISTA SURGICAL CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55725 | $5048.00 | 1407165772 - MEMORIAL HERMANN SURGERY CENTER WOODLANDS PARKWAY, LLC, MEMORIAL HERMANN SURGERY CENTER WOODLANDS PARKWAY | 273520409 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55725 | $2353.00 | 1396919783 - SURGCENTER OF SOUTHERN MARYLAND, LLC | 261572885 - (MD) SURGCENTER OF SOUTHERN MARYLAND | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55725 | $797.00 | 1962080853 - NOVANT HEALTH WILMINGTON ENDOSCOPY CENTER LLC, NOVANT HEALTH WILMINGTON ENDOSCOPY CENTER | 862943847 | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55725 | $1800.00 | 1689188823 - FLORIDA ORTHOPAEDIC INSTITUTE SURGERY CENTER LLC | 823481913 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55725 | $1500.00 | 1508437385 - SPEEDWAY SURGICAL SPECIALISTS, LLC | 852710010 - (AZ) SPEEDWAY SURGICAL SPECIALISTS LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55725 | $2795.00 | 1962568543 - ENDOSCOPY CENTER OF OCEAN COUNTY, LLC | 223461117 - (NJ) ENDOSCOPY CENTER OF OCEAN COUNTY, PC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55725 | $1212.00 | 1194718312 - CAPE COD ASC LLC | 43424805 - (MA) CAPE COD ASSOC LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55725 | $8705.00 | 1669559928 - SENATE STREET SURGERY CENTER LLC, CLARIAN HEALTH PARTNERS INC MBR | 421709357 - (IN) SENATE STREET SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55725 | $8705.00 | 1275881179 - EAGLE HIGHLANDS SURGERY CENTER, LLC, MERIDIAN SOUTH SURGERY CENTER | 352072586 | IN | 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 55725 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 55725 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 55725 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 |
| 55725-CPT | Moderate | Prostatotmy,Ext.Drain Prst.Absc;Cmp |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 55725. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 55725 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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