CPT 55842 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 |
National average reimbursement for CPT 55842 by major payers:
$1,607.39
$1,687.92
$1,689.33
$2,049.32
| 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 55842 | ||||||
United | 55842 | $1300.00 | 1558313544 - MINNESOTA VALLEY SURGERY CENTER LLC | 203371241 - (MN) MINNESOTA VALLEY SURGERY CENTER LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55842 | $775.00 | 1073987053 - SERENITY SURGICAL, LLC | 471546645 - (IN) SERENITY SURGICAL, LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55842 | $556.00 | 1235695891 - BONE AND JOINT INSTITUTE OF TENNESSEE SURGERY CENTER LLC | 832750618 - (TN) BONE AND JOINT INSTITUTE OF TENNESSEE SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55842 | $1274.00 | 1518375641 - NORTH ANAHEIM SURGERY CENTER, LLC | 364790127 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55842 | $438.00 | 1598227431 - SURGERY CENTER OF CONWAY INC | 821792579 - (SC) SURGERY CENTER OF CONWAY, INC. | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55842 | $1050.00 | 1750922142 - DERRY SURGICAL CENTER, LLC | 821436601 - (NH) DERRY SURGICAL CENTER LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55842 | $63.00 | 1225286354 - ASC DEVELOPMENT COMPANY, LLC | 203405773 - (MD) ASC DEVELOPMENT COMPANY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55842 | $3258.00 | 1346249604 - ST. MARY'S SURGICAL CENTER LLC, ST. MARY'S SURGICAL CENTER | 201685516 - (MO) ST MARYS SURGICAL CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55842 | $2172.00 | 1982607446 - DENTON SURGICARE PARTNERS, LTD., DENTON SURGICARE | 752708579 - (TX) DENTON SURGICARE PARTNERS LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55842 | $410.00 | 1255311635 - MELBOURNE ASC LP, THE SURGERY CENTER OF MELBOURNE | 621625311 - (FL) MELBOURNE ASC LP | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55842 | $750.00 | 1003272980 - PAIN CENTERS OF MINNESOTA | 352546997 - PAIN CENTERS OF MINNESOTA | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55842 | $100.00 | 1164871075 - CENTRAL ARIZONA GI & LIVER INSTITUTE LLC | 812583508 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55842 | $775.00 | 1508437385 - SPEEDWAY SURGICAL SPECIALISTS, LLC | 852710010 - (AZ) SPEEDWAY SURGICAL SPECIALISTS LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55842 | $520.00 | 1083955330 - BELLEVUE PLASTIC SURGERY CENTER, NEWVUE PLASTIC SURGERY PC | 263374369 - (WA) NEWVUE PLASTIC SURGERY, PC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55842 | $1283.00 | 1386161495 - MEDSTAR SURGERY CENTER AT BRANDYWINE, LLC | 820985178 - (MD) MEDSTAR SURGERY CENTER AT BRAN | MD | 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 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 | 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 |
| 55831-CPT | High | Prostatectomy (Including Control Of Postoperative Bleeding, Vasectomy, Meatotomy, Urethral Calibration And/Or Dilation, And Internal Urethrotomy); Retropubic, Subtotal |
| 55842-CPT | High | Prostatectomy, Retropubic Radical, With Or Without Nerve Sparing; With Lymph Node Biopsy(S) (Limited Pelvic Lymphadenectomy) |
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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