CPT 55840 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 • GC - Service performed by resident under supervision |
| Complexity Level | High |
| CMS | $1,134.07 Physician Fee Schedule |
National average reimbursement for CPT 55840 by major payers:
$1,549.23
$1,642.37
$1,721.77
$2,013.80
| 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 55840 | ||||||
United | 55840 | $1124.00 | 1023604931 - ADVANCED SPINE AND PAIN SURGERY CENTERS LLC | 854282481 - (AZ) ADVANCED SPINE AND PAIN SURGERY CENTERS LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55840 | $1124.00 | 1144333881 - NORTH SCOTTSDALE AMBULATORY SURGERY CENTER, LLC | 200554616 - (AZ) NORTH SCOTTSDALE AMBULATORY SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55840 | $1040.00 | 1639252760 - POST STREET SURGERY CENTER, LLC | 943397049 - (CA) POST STREET SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55840 | $393.00 | 1811090350 - GREEN SURGERY CENTER LLC | 621770173 - (TN) GREEN SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55840 | $1621.00 | 1386028439 - JOHNSTON MEMORIAL HOSPITAL, INC, JOHNSTON MEMORIAL SURGERY CENTER | 540544705 - JOHNSTON MEMORIAL HOSPITAL INC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55840 | $1687.00 | 1245372531 - NEWPORT BAY SURGERY CENTER, LLC | 562518360 - (CA) NEWPORT BAY SURGERY CENTER, LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55840 | $1028.00 | 1023349909 - PICCARD SURGERY CENTER, LLC | 270433723 - (MD) PICCARD SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55840 | $620.00 | 1184897472 - LAKE COUNTRY ENDOSCOPY CENTER, LLC | 261572986 - (WI) LAKE COUNTRY ENDOSCOPY CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55840 | $475.00 | 1265405203 - BLOOMFIELD EYE SURGERY CENTER LLC, THE EYE SURGERY CENTER | 621827592 - (CT) BLOOMFIELD EYE SURGERY CENTER LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55840 | $525.00 | 1104829597 - HOGAN SURGICAL CENTER, P. A. | 300399671 - (MS) HOGAN SURGICAL CENTER P A | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55840 | $622.00 | 1801952783 - AMBULATORY SURGICENTER OF DOWNERS GROVE | 364106726 - (IL) AMBULATORY SURGICENTER OF DOWNERS GROVE | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55840 | $600.00 | 1619517539 - MOUNTAIN WEST DERM | 813253496 | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55840 | $619.00 | 1912909144 - THE UROLOGY CENTER, PC, UROLOGY CENTER ASC | 470593275 - (NE) THE UROLOGY CENTER, P.C. | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55840 | $6310.00 | 1649482449 - METHODIST HEALTHCARE SYSTEM OF SAN ANTONIO, LTD., L.L.P., METHODIST HOSPITAL | 742730328 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55840 | $247.00 | 1205804697 - GOLDSBORO ENDOSCOPY CENTER INC | 562003095 - (NC) GOLDSBORO ENDOSCOPY CENTER INC | NC | 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 55840 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 55840 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 55840 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) |
| 55815-CPT | High | Removal Of Prostate Gland Through Incision Between Scrotum And Anus And Removal Of Surrounding Lymph Nodes On Both Sides Of Pelvis |
| 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 |
| 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 55840. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 55840 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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