CPT 55870 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-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 • 19 - Off Campus Outpatient Hospital |
| Common Modifiers | • None • PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments • 52 - Reduced Services |
| Complexity Level | Moderate |
| CMS | $174.67 Physician Fee Schedule |
National average reimbursement for CPT 55870 by major payers:
$223.18
$231.55
$244.93
$295.44
| 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 55870 | ||||||
United | 55870 | $570.00 | 1548712227 - ARKANSAS OUTPATIENT SURGERY CENTER, LLC | 474672200 - (AR) ARKANSAS OUTPATIENT SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55870 | $375.00 | 1710985445 - HERSHEY ENDOSCOPY CENTER, LLC | 562336622 - (PA) HERSHEY ENDOSCOPY CENTER, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55870 | $1886.00 | 1982880274 - BURLINGTON COUNTY ENDOSCOPY CENTER LLC | 208205206 - (NJ) BURLINGTON COUNTY ENDOSCOPY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55870 | $425.50 | 1679612253 - WALKER SURGICAL CENTER LLC | 810635117 - (MI) WALKER SURGICAL CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55870 | $540.00 | 1568814010 - SURGERY CENTER OF CALIFORNIA -LLC | 812978830 - (CA) SURGERY CENTER OF CALIFORNIA LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55870 | $720.00 | 1811076623 - SPARTANBURG SURGERY CENTER, LLC | 570953005 - (SC) SPARTANBURG SURGERY CENTER LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55870 | $767.00 | 1932530284 - VP SURGERY CENTER OF AUBURN LLC | 371668651 - (WA) VP SURGERY CENTER OF AUBURN LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55870 | $363.00 | 1255373676 - EYE SURGERY CENTERS OF NEW MEXICO, LLC, SURGERY CENTER OF SANTA FE | 850478109 - (NM) EYE SURGERY CENTERS OF NEW MEXICO LLC | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55870 | $750.00 | 1831139955 - ABINGTON SURGICAL CENTER | 232561054 - (PA) ABINGTON SURGICAL CENTER | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55870 | $1358.00 | 1891717195 - CENTER FOR PAIN MANAGEMENT LLC, TUCSON UROLOGIC SURGERY CENTER | 830962530 - (AZ) CENTER FOR PAIN MANAGEMENT LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55870 | $800.00 | 1669621496 - CPM SURGERY CENTER 3, LLC | 263297851 - (GA) CPM SURGERY CENTER 3 LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55870 | $1296.00 | 1942231204 - SURGICAL INSTITUTE, LLC | 810911558 - (NJ) SURGICAL INSTITUTE LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55870 | $355.00 | 1891772547 - NOVAMED SURGERY CENTER OF BATON ROUGE LLC, INTERVENTIONAL PAIN MANAGEMENT CENTER | 262609309 - (LA) NOVAMED SURGERY CENTER OF BATON ROUGE LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55870 | $1050.00 | 1730603622 - DULUTH SURGICAL SUITES LLC | 820668583 - (MN) DULUTH SURGICAL SUITES LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55870 | $200.00 | 1568448660 - PROGRESSIVE SURGICAL INSTITUTE INC. | 232973820 - (PA) PROGRESSIVE SURGICAL INSTITUTE INC | PA | 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 55870 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 55870 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 55870 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 |
|---|---|---|
| 55700-CPT | Moderate | Biopsy Prostate Needle/Punch |
| 55870-CPT | Moderate | Electroejaculation |
| 55873-CPT | High | Cryosurgical Ablation Of The Prostate (Includes Ultrasonic Guidance For Interstitial Cryosurgical Probe Placement) |
| 55875-CPT | Moderate | Transperineal Placement Of Needles Or Catheters Into Prostate For Interstitial Radioelement Application With Or Without Cystocopy |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 55870. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 55870 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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