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See a sample rate comparisonCPT 55867 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.
Laps Surg Prst8ect Smpl Stot, Laparoscopy Surgical Prostatectomy Simple Subtotal Including Control Of Postoperative Bleeding Vasectomy Meatotomy Urethral Calibration And Or Dilation And Internal Urethrotomy Includes Robotic Assistance When Performed
| 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 55867 |
| Medicaid Fee Schedule | View Medicaid rates for 55867 |
National average reimbursement for CPT 55867 by major payers:
$1,364.13
$1,450.89
$1,424.71
$1,727.63
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CPT 55867
5 of 25 sample ratesHigher to lower in this preview
Howard Community Surgery Center LLC
$12,945.00Published rateOak Tree Surgery Center, LLC
Oak Tree Surgery Center, Ll, LLC
$5,330.00Published rateMaryland Surgery Center For Women
Maryland Surgery Center For Women, LLC
$3,605.00Published rateExecutive Park Surgery Center Of Fort Smith, Inc
$1,950.00Published rateSurgery Center At Corporate Way LLC
$965.00Published rate
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See a sample payer proposalCPT 55867 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 55867 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 55867 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 |
|---|---|---|
| 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). |
| 55867-CPT | High | Laps Surg Prst8ect Smpl Stot, Laparoscopy Surgical Prostatectomy Simple Subtotal Including Control Of Postoperative Bleeding Vasectomy Meatotomy Urethral Calibration And Or Dilation And Internal Urethrotomy Includes Robotic Assistance When Performed |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 55867. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 55867 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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