CPT 55815 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 |
| Complexity Level | High |
| CMS | $1,699.81 Physician Fee Schedule |
National average reimbursement for CPT 55815 by major payers:
$2,268.16
$2,359.37
$2,410.72
$2,935.72
| 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 55815 | ||||||
United | 55815 | $104.00 | 1578535233 - SUN CITY OPHTHALMOLOGY ASC LLC, EYE INSTITUTE AT BOSWELL | 621737549 - (AZ) SUN CITY OPHTHALMOLOGY ASSOC LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55815 | $2732.00 | 1720566433 - PAVILION SURGICENTER, LLC, PHYSICIANS PAVILION SURGERY CENTER | 830619935 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55815 | $706.00 | 1659679074 - EYE SURGERY CENTER OF MIDDLE TENNESSEE, LLC | 275124581 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55815 | $322.00 | 1205917101 - CATARACT & LASER CENTER, INC. | 42907424 - (MA) THE CATARACT AND LASER CENTER, I | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55815 | $909.00 | 1265401202 - NORTHWEST ORTHOPAEDIC SPECIALISTS, P.S., THE ORTHOPAEDIC SURGERY CENTER | 911502837 - NORTHWEST ORTHOPAEDIC SPECIALISTS, P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55815 | $100.00 | 1679566582 - FOREST CANYON ENDOSCOPY & SURGERY CTR PC | 460504121 - (AZ) FOREST CANYON ENDOSCOPY & SURGERY CENTER, PC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55815 | $135.00 | 1407539539 - RSC SURGERY CENTER, LLC | 352345966 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55815 | $2737.00 | 1174591143 - SILICON VALLEY SURGERY CENTER, LP | 770495522 - (CA) SILICON VALLEY SURGERY CENTER, L.P. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55815 | $525.00 | 1962959296 - RUSH-COPLEY SURGICENTER, LLC, CASTLE SURGICENTER | 384012268 | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55815 | $1064.00 | 1992992994 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55815 | $556.00 | 1134427297 - SURGERY CENTER OF ZACHARY, LLC | 811928790 - (LA) SURGERY CENTER OF ZACHARY, LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55815 | $129.00 | 1073620415 - NORTH BAY EYE ASSOCIATES A MEDICAL CORPORATION, NORTH BAY EYE ASSOCIATES ASC | 680368973 - (CA) NORTH BAY EYE ASSOCIATES | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55815 | $1064.00 | 1154956928 - ADVANCED SURGICAL CARE OF CLEARWATER LLC | 833698204 - (FL) ADVANCED SURGICAL CARE OF CLEARWATER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55815 | $6068.00 | 1023316197 - NORTH DALLAS SURGICAL CENTER,LLC, TEXAS HEALTH SURGERY CENTER ADDISON | 272248103 - (TX) NORTH DALLAS SURGICAL CENTERLLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55815 | $673.00 | 1760423180 - CENTRAL COAST ENDOSCOPY CENTER INC | 770456846 - (CA) CENTRAL COAST ENDOSCOPY CENTER INC | 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 55815 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 55815 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 55815 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 |
|---|---|---|
| 55812-CPT | High | Prostatctmy,Pernl.Rad;Lymph Node Bx |
| 55815-CPT | High | Removal Of Prostate Gland Through Incision Between Scrotum And Anus And Removal Of Surrounding Lymph Nodes On Both Sides Of Pelvis |
| 55831-CPT | High | Prostatectomy (Including Control Of Postoperative Bleeding, Vasectomy, Meatotomy, Urethral Calibration And/Or Dilation, And Internal Urethrotomy); Retropubic, Subtotal |
| 55840-CPT | High | Prostatectomy, Retropubic Radical; |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 55815. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 55815 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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