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 |
| Medicare Fee Schedule | View Medicare rates for 55725 |
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 | $8705.00 | 1275881179 - EAGLE HIGHLANDS SURGERY CENTER, LLC, MERIDIAN SOUTH SURGERY CENTER | 352072586 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55725 | $1685.00 | 1508934373 - CENTERS FOR PAIN SOLUTIONS,LLC | 20522938 - (NH) CENTERS FOR PAIN SOLUTIONSLLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55725 | $2859.00 | 1225579295 - SANTA BARBARA OUTPATIENT SURGERY CENTERS LLC, SANTA BARBARA SURGERY CENTER | 371846158 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55725 | $3995.00 | 1770847717 - ENDOSCOPY CENTER OF HACKENSACK, LLC, HACKENSACK ENDOSCOPY CENTER | 453948948 | NJ | 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 | $2388.00 | 1871594275 - DESTIN SURGERY CENTER LLC | 593723179 - (FL) DESTIN SURGERY CENTER LLC | FL | 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 | $2292.00 | 1215338868 - MEMORIALCARE SURGICAL CENTER AT SADDLEBACK LLC, LAGUNA NIGUEL SURGERY CENTER | 203678259 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55725 | $1900.00 | 1558313544 - MINNESOTA VALLEY SURGERY CENTER LLC | 203371241 - (MN) MINNESOTA VALLEY SURGERY CENTER LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55725 | $11365.65 | 1902920622 - WEST PENN ALLEGHENY HEALTH SYSTEM INC., ALLEGHENY GENERAL HOSPITAL | 250969492 - (PA) HIGHMARK HEALTH | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55725 | $1403.00 | 1336154152 - A CENTER FOR FOOT AND ANKLE SURGERY PA, THE CENTER FOR SPECIAL SURGERY OF HAWTHORNE | 223284458 - (NJ) A CENTER FOR FOOT AND ANKLE SU | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55725 | $2388.00 | 1750499950 - MEDPLEX OUTPATIENT SURGERY CENTER LTD, MEDPLEX OUTPATIENT SURGERY CENTER | 760353620 - (AL) MEDPLEX OUTPATIENT SURGERY CENTER LTD | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55725 | $1563.00 | 1497090740 - OLOL PONTCHARTRAIN SURGERY CENTER, LLC, OUR LADY OF THE LAKE PONTCHARTRAIN SURGERY CENTER | 461379031 - (LA) OLOL PONTCHARTRAIN SURGERY CENTE | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55725 | $1424.00 | 1942207196 - GRAND VALLEY SURGICAL CENTER, LLC | 841505075 - (CO) GRAND VALLEY SURGICAL CENTER, LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55725 | $4577.00 | 1619944824 - WAVERLEY SURGERY CENTER LLC, WAVERLEY SURGERY CENTER | 20554398 - (CA) WAVERLEY SURGERY CENTER, L.P. | CA | 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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