CPT 55867 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 | • 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 |
National average reimbursement for CPT 55867 by major payers:
$1,364.13
$1,450.89
$1,424.71
$1,799.42
| 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 55867 | ||||||
United | 55867 | $1200.00 | 1609955517 - KNOXVILLE EYE SURGERY CENTER LLC, TENNESSEE VALLEY EYE CENTER | 621680280 - (TN) KNOXVILLE EYE SURGERY CENTER, LLC; DBA TENNESSEE VALLEY EYE CENTER | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55867 | $4570.00 | 1679001028 - CENTERVIEW SURGERY CENTER, LLC | 815461133 - (AR) CENTERVIEW SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55867 | $5716.60 | 1447221486 - ORTHOPAEDIC OUTPATIENT SURGERY CENTER, LLC | 421508092 - (IA) ORTHOPAEDIC OUTPATIENT SURGERY CENTER LLC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55867 | $4100.00 | 1760923445 - DIALYSIS ACCESS CENTER A MEDICAL CORPORATION | 522384032 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55867 | $1305.00 | 1235117052 - ALLEGANY AMBULATORY SURGERY CENTER LLC | 522268598 - (MD) ALLEGANY AMBULATORY SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55867 | $4577.00 | 1184664609 - ENDOSCOPY CENTER AT ROBINWOOD, LLC | 20615867 - (MD) ENDOSCOPY CENTER AT ROBINWOOD LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55867 | $3041.00 | 1740491422 - PV PENINSULA PLASTIC SURGERY CENTER | 208545497 - (CA) PV PENINSULA PLASTIC SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55867 | $6450.00 | 1184009326 - AMBULATORY CENTER FOR ENDOSCOPY, LLC, HUDSON BERGEN ENDO-SURGICAL CENTER | 200064962 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55867 | $3197.00 | 1164582649 - STRICTLY PEDIATRICS SURGERY CENTER OF CENTRAL TEXAS, LLC, STRICTLY PEDIATRICS SURGERY CENTER | 200943974 - (TX) STRICTLY PEDIATRICS SURGERY CENTER OF TEXAS, LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55867 | $3690.00 | 1942540851 - THE ORTHOPAEDIC AND SPINE CENTER OF SOUTHERN COLORADO, LLC | 461852637 - (CO) THE ORTHOPAEDIC & SPINE CENTER OF S COLORADO | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55867 | $5330.00 | 1205929080 - OAK TREE SURGERY CENTER, LLC | 223524889 - (NJ) OAK TREE SURGERY CENTER, LL, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55867 | $965.00 | 1760849889 - SURGERY CENTER AT CORPORATE WAY LLC | 473812657 - (OH) SURGERY CENTER AT CORPORATE WAY LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55867 | $2500.00 | 1750884052 - PRECISION SURGERY CENTER PLLC | 824729968 - (ID) PRECISION SURGERY CENTER PLLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55867 | $6588.00 | 1740794973 - EPIC ASC, LLC, EPIC SURGERY CENTER | 611859657 | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55867 | $3605.00 | 1184072308 - MARYLAND SURGERY CENTER FOR WOMEN | 522215638 - (MD) MARYLAND SURGERY CENTER FOR WOMEN, LLC | 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 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 |
|---|---|---|
| 55810-CPT | High | Prostectmy,Incl Contrl Postop Bleed Dur Init Hosp,Comp(Vasectmy,Meatmy,Ureth Calib/Dil,Int Urethrtmyincl);Perineal, Radical |
| 55831-CPT | High | Prostatectomy (Including Control Of Postoperative Bleeding, Vasectomy, Meatotomy, Urethral Calibration And/Or Dilation, And Internal Urethrotomy); Retropubic, Subtotal |
| 55862-CPT | High | Exposure Of Prostate, Any Approach, For Insertion Of Radioactive Substance; With Lymph Node Biopsy(S) (Limited Pelvic Lymphadenectomy) |
| 55867-CPT | High | 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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