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See a sample rate comparisonCPT 55842 Fee Schedule
Last Verified: October 2026
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.
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).
| 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 |
| Medicare Fee Schedule | View Medicare rates for 55842 |
| Medicaid Fee Schedule | View Medicaid rates for 55842 |
National average reimbursement for CPT 55842 by major payers:
$1,607.39
$1,687.92
$1,689.33
$2,001.26
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CPT 55842
5 of 25 sample ratesHigher to lower in this preview
1-4 Surgical Services, LLC
14 Surgical Services LLC
$5,500.00Published rateValley Baptist Ambulatory Surgery Center, LLC, Platinum Surgery Center
$1,274.00Published rateAdvanced Surgery Center Of Bethesda, LLC
Asc Bethesda
$936.00Published rateUpnt Surgery LLC
$615.00Published rateNorthlake Endoscopy, LLC
Northlake Endoscopy LLC
$404.00Published rate
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See a sample payer proposalCPT 55842 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 55842 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 55842 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 |
|---|---|---|
| 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). |
| 55831-CPT | High | Prostatectomy (Including Contr, Prostatectomy (Including Control Of Postoperative Bleeding Vasectomy Meatotomy Urethral Calibration Andor Dilation And Internal Urethrotomy) Retropubic Subtotal |
| 55840-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). |
| 55842-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). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 55842. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 55842 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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