CPT 55812 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 |
| Common Modifiers | None AS - PA/NP/CNS assistant at surgery UB 80 - Assistant surgeon |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 55812 |
National average reimbursement for CPT 55812 by major payers:
$1,969.02
$2,150.95
$2,201.65
$2,677.10
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 55812 | $444.00 | 1962080853 - NOVANT HEALTH WILMINGTON ENDOSCOPY CENTER LLC, NOVANT HEALTH WILMINGTON ENDOSCOPY CENTER | 862943847 | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55812 | $4165.00 | 1528438884 - MCLEAN AMBULATORY SURGERY, LLC | 474966649 - (VA) MCLEAN AMBULATORY SURGERY LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55812 | $494.00 | 1225199482 - ST MARKS SURGICAL CENTER LLC | 364577700 - (FL) ST MARKS SURGICAL CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55812 | $1306.00 | 1831275775 - NORTH JERSEY GASTROENTEROLOGY & ENDOSCOPY CENTER P.A. | 223637494 - (NJ) NORTH JERSEY GASTROENTEROLOGY ENDOSCOPY CENTER PA | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55812 | $740.00 | 1629313739 - COLTON CA MULTI ASC LP, PREMIER OUTPATIENT SURGERY CENTER | 461462978 - (CA) COLTON CA MULTI ASC LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55812 | $983.00 | 1245711803 - SURGCENTER CLEARWATER, LLC, SURGCENTER DUNEDIN | 823682684 - (FL) SURGCENTER CLEARWATER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55812 | $2172.00 | 1073694550 - ROCKWALL AMBULATORY SURGERY CENTER LLP, BAYLOR SCOTT & WHITE SURGICARE - ROCKWALL | 205506447 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55812 | $2506.00 | 1700057254 - NORTH STATE SURGERY CENTERS, LP, MERCY SURGERY CENTER | 300197423 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55812 | $1043.00 | 1154322410 - SUMMIT SURGICAL SUITES, LLC, SOUTHWEST SURGICAL SUITES | 383641574 - (IN) SUMMIT SURGICAL SUITES LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55812 | $450.00 | 1578094462 - AMERICAN ACCESS CARE OF JACKSONVILLE ASC LLC, AZURA SURGERY CENTER JACKSONVILLE | 814635841 - (FL) AMERICAN ACCESS CARE OF JACKSONVILLE ASC LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55812 | $1682.00 | 1598258865 - NORTHERN WESTCHESTER FACILITY PROJECT LLC, YORKTOWN CENTER FOR SPECIALTY SURGERY | 383989643 - (NY) NORTHERN WESTCHESTER FACILITY PROJECT LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55812 | $2785.00 | 1083912745 - RED ROCKS SURGERY CENTERS, LLC | 271095323 - (CO) RED ROCKS SURGERY CENTERS LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55812 | $566.00 | 1174679054 - CROSSROADS SURGERY CENTER, LLC | 562622609 - (TN) CROSSROADS SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55812 | $6659.00 | 1659519684 - SOUTH CAMPUS SURGERY CENTER | 352038072 - (IN) SOUTH CAMPUS SURGERY CENTER | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55812 | $450.00 | 1710420120 - AMERICAN ACCESS CARE OF MIAMI ASC LLC, AZURA SURGERY CENTER MIAMI | 814118495 - (FL) AMERICAN ACCESS CARE OF MIAMI ASC 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 55812 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 55812 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 55812 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 |
|---|---|---|
| 55810-CPT | High | Surgery To Remove Prostate, Surgery To Remove The Entire Prostate Gland Along With The Seminal Vesicles. The Procedure May Include Removing Lymph Nodes In The Groin Or Abdomen Or Taking A Sample Of Tissue For Testing (Biopsy). |
| 55812-CPT | High | Surgery To Remove Prostate, Surgery To Remove The Entire Prostate Gland Along With The Seminal Vesicles. The Procedure May Include Removing Lymph Nodes In The Groin Or Abdomen Or Taking A Sample Of Tissue For Testing (Biopsy). |
| 55815-CPT | High | Surgery To Remove Prostate, Surgery To Remove The Entire Prostate Gland Along With The Seminal Vesicles. The Procedure May Include Removing Lymph Nodes In The Groin Or Abdomen Or Taking A Sample Of Tissue For Testing (Biopsy). |
| 55821-CPT | High | Removal Of Prostate, Prostatectomy Including Control Of Postoperative Bleeding Vasectomy Meatotomy Urethral Calibration And Or Dilation And Internal Urethrotomy Suprapubic Subtotal 1 Or 2 Stages |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 55812. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 55812 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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