CPT 55801 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 • 51 - Multiple procedures • AA - Anesthesia by anesthesiologist • GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 55801 |
National average reimbursement for CPT 55801 by major payers:
$1,322.52
$1,456.50
$1,504.81
$1,821.72
| 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 55801 | ||||||
United | 55801 | $386.00 | 1215957816 - SURGERY CENTER OF CENTRAL VIRGINIA INC., D.B.A. EYE SURGERY CENTER | 541816412 - (VA) SURGERY CENTER OF CENTRAL VIRGINIA INC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55801 | $2172.00 | 1487371431 - BAYLOR SCOTT & WHITE SURGICARE WAXAHACHIE LLC | 920758698 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55801 | $2705.00 | 1639850415 - MEDICAL CITY SURGERY CENTER OF ALLEN, LLC | 932106228 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55801 | $2228.00 | 1184814782 - PUNXSUTAWNEY AREA HOSPITAL INC | 250965210 - (PA) PUNXSUTAWNEY AREA HOSPITAL INC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55801 | $853.00 | 1831217231 - THE ENDOSCOPY CENTER AT BAINBRIDGE LLC | 205430025 - (OH) THE ENDOSCOPY CENTER AT BAINBRIDGE LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55801 | $1955.00 | 1124083076 - NORTH GARLAND SURGERY CENTER LLP, BAYLOR SCOTT & WHITE SURGICARE - NORTH GARLAND | 562399993 - (TX) NORTH GARLAND SURGERY CENTER LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55801 | $410.00 | 1265438303 - EYE SURGERY CENTER OF CHATTANOOGA, LLC | 200149350 - (TN) EYE SURGERY CENTER OF CHATTANOOGA LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55801 | $350.00 | 1033213269 - CAPE COD EYE SURGERY & LASER CENTER, LLC, CAPE COD EYE SURGERY & LASER CENTER | 43398899 - (MA) CAPE COD EYE SURGERY & LASER CENTER, LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55801 | $1049.00 | 1649515354 - SURGCENTER NORTHEAST LLC | 455554995 - (FL) SURGCENTER NORTHEAST, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55801 | $510.00 | 1114483492 - ORANGE COUNTY DIGESTIVE CENTER, INC | 832144265 - (CA) ORANGE COUNTY DIGESTIVE CENTER, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55801 | $100.00 | 1609039056 - FARSHID PAYDAR MD PC, THE EYE CLINIC | 454779006 - (AZ) FARSHID PAYDAR MD PC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55801 | $604.00 | 1447991138 - SILVER STATE SURGERY CENTER WEST LLC | 872764352 - (NV) SILVER STATE SURGERY CENTER WEST LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55801 | $553.00 | 1881002343 - INNOVATIVE SURGERY CENTER, LLC | 471395981 - (MD) INNOVATIVE SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55801 | $1528.00 | 1790320612 - GS CAMPUS ASC, LLC, LAFAYETTE SURGERY CENTER | 821536566 - (CO) GS CAMPUS ASC LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55801 | $481.00 | 1669050654 - HEART & VASCULAR AMBULATORY SURGERY CENTER, LLC | 862335325 - (FL) HEART VASCULAR AMBULATORY SURGERY CENTER LLC | FL | 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 55801 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 55801 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 55801 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 |
|---|---|---|
| 55801-CPT | High | Prostatectomy, Perineal, Subtotal (Including Control Of Postoperative Bleeding, Vasectomy, Meatotomy, Urethral Calibration And/Or Dilation, And Internal Urethrotomy) |
| 55810-CPT | High | Prostectmy,Incl Contrl Postop Bleed Dur Init Hosp,Comp(Vasectmy,Meatmy,Ureth Calib/Dil,Int Urethrtmyincl);Perineal, Radical |
| 55821-CPT | High | Prostatectomy (Including Control Of Postoperative Bleeding, Vasectomy, Meatotomy, Urethral Calibration And/Or Dilation, And Internal Urethrotomy); Suprapubic, Subtotal, 1 Or 2 Stages |
| 55831-CPT | High | Prostatectomy (Including Control Of Postoperative Bleeding, Vasectomy, Meatotomy, Urethral Calibration And/Or Dilation, And Internal Urethrotomy); Retropubic, Subtotal |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 55801. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 55801 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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