CPT 55873 Fee Schedule
Last Updated: August 2025
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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 22 - Increased Procedural Services (surgical/procedures codes only) • GC - Service has been performed in part by a resident under the direction of a teaching physician |
| Complexity Level | High |
National average reimbursement for CPT 55873 by major payers:
$5,256.62
$6,828.25
$7,978.67
$9,289.75
Find Fee Schedule & Reimbursement for Other Codes
Use our free lookup tool to explore fee schedules and reimbursement rates for any billing code. Select a code type, then type or select a code to view its details.
Related Codes
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 55873. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 55873 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.
CPT 55873 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 55873 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 55873 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.
| CPT Code | Complexity Level | Description |
|---|---|---|
| 55870 | Moderate | Electroejaculation |
| 55873 | High | Cryosurgical Ablation Of The Prostate (Includes Ultrasonic Guidance For Interstitial Cryosurgical Probe Placement) |
| 55874 | High | Transperineal Placement Of Biodegradable Material Peri-Prostatic Single Or Multiple Injection(S) Including Image Guidance When Performed |
| 55875 | Moderate | Transperineal Placement Of Needles Or Catheters Into Prostate For Interstitial Radioelement Application With Or Without Cystocopy |
See what providers are getting paid in 2025 for 55873:
CPT 55873 Fee Schedule & Reimbursement Rates
The CPT 55873 fee schedule varies by payer type. Below are Medicare rates for 2025 and average in-network rates by state across major payers:
| Code | Medicare Rate | Avg. BCBS National Rate | More Info |
|---|---|---|---|
| 55870 | $178.42 | $223.18 | |
| 55873 | $5,664.87 | $5,256.62 | |
| 55874 | $2,836.76 | $3,693.85 | |
| 55875 | $775.93 | $980.93 | |
| 55876 | $151.46 | $180.98 |
Reimbursement rates depend on provider contracts, region, and payer. Always verify rates with your insurance provider or medical billing department.
What is Price Transparency?
The Price Transparency Rule is a federal law that took effect in July 2022, requiring all commercial payers to publicly disclose their prices through machine-readable files (MRFs). This landmark regulation mandates that insurance companies make healthcare costs transparent to the public.
Our data comes directly from these insurer-posted MRFs, ensuring compliance with the Price Transparency Rule. While PayerPrice is working toward a future where providers and payers collaborate for 100% upfront price certainty, it's important to acknowledge that data limitations and occasional errors may exist.
Unlock access to price transparency insights today
First Name
Last Name
Role / Title
Company
How did you hear about us?
PayerPrice needs the contact information you provide to us to contact you about our products and services. You may unsubscribe from these communications at any time. For information on how to unsubscribe, as well as our privacy practices and commitment to protecting your privacy, please review our Privacy Policy.