CPT 55865 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 | • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None |
| Complexity Level | High |
National average reimbursement for CPT 55865 by major payers:
$1,674.71
$1,787.32
$1,825.08
$2,227.63
| 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 55865 | ||||||
United | 55865 | $1028.00 | 1891298089 - MICHIGAN OUTPATIENT SURGICAL SOLUTIONS, LLC | 821706937 - (MI) MICHIGAN OUTPATIENT SURGICAL SOLUTIONS LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55865 | $2506.00 | 1700057254 - NORTH STATE SURGERY CENTERS, LP, MERCY SURGERY CENTER | 300197423 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55865 | $953.00 | 1982211728 - FT SCOTT SURGERY CENTER LLC | 853127325 | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55865 | $4251.00 | 1164776266 - UNIVERSITY OF KANSAS HOSPITAL | 481202402 - UNIVERSITY OF KANSAS HOSPITAL AUTHORITY | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55865 | $650.00 | 1619559044 - ASCENT SURGERY CENTER, LLC | 853327359 - (OH) ASCENT SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55865 | $1049.00 | 1962714154 - SURGCENTER OF WHITE MARSH, LLC | 272873637 - (MD) SURGCENTER OF WHITE MARSH, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55865 | $1000.00 | 1164019485 - WAUKESHA SURGICENTER, LLC | 854083608 - (WI) WAUKESHA SURGICENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55865 | $492.00 | 1376115816 - BARNET DULANEY PERKINS EYE CENTER, PC, AMERICAN VISION PARTNERS | 562589722 - BARNET DULANEY PERKINS EYE CENTER PLLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55865 | $531.00 | 1528369972 - INSIGHT GROUP, LLC | 261871061 - (LA) INSIGHT GROUP LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55865 | $1262.00 | 1144287665 - CHANNEL ISLANDS SURGICENTER LP | 770418197 - (CA) CHANNEL ISLANDS SURGICENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55865 | $581.00 | 1245868488 - AVON SURGERY CENTER, LLC | 823987550 - (OH) AVON SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55865 | $422.00 | 1689657058 - CENTER FOR ADVANCED EYE SURGERY, LTD | 341866635 - (OH) CENTER FOR ADVANCED EYE SURGERY LTD | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55865 | $637.00 | 1184195877 - ALPINE SURGICENTER, LLC | 204038061 | AK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55865 | $983.00 | 1801146535 - SURGCENTER AT PARADISE VALLEY, LLC, SURGCENTER AT PIMA CROSSING | 455364868 - (AZ) SURGCENTER AT PARADISE VALLEY | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55865 | $210.00 | 1790167740 - TIDALHEALTH SURGERY CENTER, LLC | 474184623 | 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 55865 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 55865 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 55865 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 |
|---|---|---|
| 55842-CPT | High | Prostatectomy, Retropubic Radical, With Or Without Nerve Sparing; With Lymph Node Biopsy(S) (Limited Pelvic Lymphadenectomy) |
| 55860-CPT | High | Exposure Prostate W Insert Isotope |
| 55862-CPT | High | Exposure Of Prostate, Any Approach, For Insertion Of Radioactive Substance; With Lymph Node Biopsy(S) (Limited Pelvic Lymphadenectomy) |
| 55865-CPT | High | Exposure Of Prostate, Any Approach, For Insertion Of Radioactive Substance; With Bilateral Pelvic Lymphadenectomy, Including External Iliac, Hypogastric And Obturator Nodes |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 55865. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 55865 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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