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See a sample rate comparisonCPT 55866 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 | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | None AS - PA/NP/CNS assistant at surgery 80 - Assistant surgeon |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 55866 |
| Medicaid Fee Schedule | View Medicaid rates for 55866 |
National average reimbursement for CPT 55866 by major payers:
$1,750.10
$2,046.72
$2,150.91
$2,275.38
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CPT 55866
5 of 25 sample ratesHigher to lower in this preview
Marguerite Poreda
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
$2,460.43Published rateHien Liu
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
$2,460.43Published rateSonya Pflanzer
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
$2,091.37Published rateRachel Morgan
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
$2,091.37Published rateAnn Guastella
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
$2,050.37Published rate
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See a sample payer proposalCPT 55866 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 55866 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 55866 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 |
|---|---|---|
| 55860-CPT | High | Radiation Therapy Of Prostate, Placement Of Radioactive Seeds For Treatment Of The Prostate Gland. The Procedure May Include Removing A Sample Of Tissue For Testing (Biopsy) Or Removing One Or More Lymph Nodes. |
| 55862-CPT | High | Radiation Therapy Of Prostate, Placement Of Radioactive Seeds For Treatment Of The Prostate Gland. The Procedure May Include Removing A Sample Of Tissue For Testing (Biopsy) Or Removing One Or More Lymph Nodes. |
| 55865-CPT | High | Radiation Therapy Of Prostate, Placement Of Radioactive Seeds For Treatment Of The Prostate Gland. The Procedure May Include Removing A Sample Of Tissue For Testing (Biopsy) Or Removing One Or More Lymph Nodes. |
| 55866-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 55866. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 55866 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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