CPT 55831 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 • AS - PA/NP/CNS assistant at surgery • 80 - Assistant surgeon |
| Complexity Level | High |
| CMS | $834.86 Physician Fee Schedule |
National average reimbursement for CPT 55831 by major payers:
$1,140.40
$1,255.72
$1,281.23
$1,509.14
| 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 55831 | ||||||
United | 55831 | $410.00 | 1346740719 - DIALYSIS ACCESS CENTER CORPUS CHRISTI ASC LLC | 815113661 - (TX) DIALYSIS ACCESS CENTER CORPUS CHRISTI ASC LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55831 | $2156.00 | 1346270329 - MARY IMMACULATE AMBULATORY SURGERY CENTER LLC | 200485202 - (VA) MARY IMMACULATE AMBULATORY SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55831 | $500.00 | 1225387640 - PCET SURGERY CENTER LLC | 454288531 - (TN) PCET SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55831 | $11727.00 | 1396901542 - TEXAS HEALTH ARLINGTON MEMORIAL HOSPITAL | 750972805 - (TX) TEXAS HEALTH ARLINGTON MEMORIAL HOSPITAL | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55831 | $592.00 | 1447991138 - SILVER STATE SURGERY CENTER WEST LLC | 872764352 - (NV) SILVER STATE SURGERY CENTER WEST LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55831 | $100.00 | 1619971470 - ARIZONA ADVANCED SURGERY CENTER, LLC | 202770438 - (AZ) ARIZONA ADVANCED SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55831 | $1285.00 | 1508851213 - FROEDTERT SURGERY CENTER, LLC | 201499345 - (WI) FROEDTERT SURGERY CENTER, LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55831 | $560.00 | 1821106923 - ENDOSCOPY CENTER OF COASTAL GEORGIA, LLC | 582628189 - (GA) ENDOSCOPY CENTER OF COASTAL GEORGIA LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55831 | $480.00 | 1740785096 - GASTROINTESTINAL ENDOSCOPY CENTER LLC | 822081770 - (PA) GASTROINTESTINAL ENDOSCOPY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55831 | $1028.00 | 1366935074 - SKYWAY SURGERY CENTER, LLC | 813237016 - (FL) SKYWAY SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55831 | $922.00 | 1023734084 - WEST GEORGIA SURGERY CENTER, LLC | 833671516 - (GA) TANNER MEDICAL CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55831 | $298.00 | 1003858721 - PIEDMONT ENDOSCOPY CENTER, INC. | 561634105 | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55831 | $6068.00 | 1902844426 - SOUTH ARLINGTON SURGICAL PROVIDERS, LLC, SAME DAY SURGICARE | 752723958 - (TX) SOUTH ARLINGTON SURGICAL PROVIDERS LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55831 | $347.00 | 1033223367 - SOUTHEASTERN OUTPATIENT SURGERY CENTER LLC | 201379958 - (FL) SOUTHEASTERN OUTPATIENT SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55831 | $1064.00 | 1356396857 - HOLSTON VALLEY AMBULATORY SURGERY CENTER, LLC | 621816864 | TN | 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 55831 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 55831 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 55831 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) |
| 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 |
| 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 55831. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 55831 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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