CPT 55875 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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 58 - Staged or related procedure during postoperative period • SG - Scene to Hospital ESRD facility |
| Complexity Level | Moderate |
| CMS | $763.05 Physician Fee Schedule |
National average reimbursement for CPT 55875 by major payers:
$980.93
$1,021.61
$1,104.70
$1,309.18
| 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 55875 | ||||||
United | 55875 | $2211.00 | 1174258107 - FW SPECIALTY SURGICARE, LLC | 854261198 - (TX) FW SPECIALTY SURGICARE LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55875 | $2600.00 | 1902438112 - SURGERY CENTER OF SAN DIEGO, LLC | 833107404 - (CA) SURGERY CENTER OF SAN DIEGO LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55875 | $2359.00 | 1700843208 - FAYETTEVILLE AMBULATORY SURGERY CENTER LIMITED PARTNERSHIP, FAYETTEVILLE AMBULATORY SURGERY CENTER | 561754482 - (NC) FAYETTEVILLE AMBULATORY SURGERY | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55875 | $859.00 | 1649218009 - RIVER DRIVE SURGERY CENTER, LLC, RIVER DRIVE SURGERY AND LASER CENTER | 223672648 - (NJ) RIVER DRIVE SURGERY CENTER L L | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55875 | $1230.00 | 1093960395 - GRAYSTONE EYE SURGERY CENTER LLC | 205740206 | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55875 | $981.00 | 1730614330 - GYPSY LANE ENDOSCOPY SUITES, INC. | 475672535 - (OH) GYPSY LANE ENDOSCOPY SUITES INC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55875 | $1823.00 | 1811345267 - CAROLINAS AMBULATORY SURGERY INC., ATRIUM HEALTH SURGERY CENTER ROCK HILL | 812714217 - (SC) CAROLINAS AMBULATORY SURGERY INC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55875 | $5320.00 | 1144287665 - CHANNEL ISLANDS SURGICENTER LP | 770418197 - (CA) CHANNEL ISLANDS SURGICENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55875 | $2984.00 | 1689163875 - VASCULAR ACCESS CENTERS OF ILLINOIS AT MORGAN PARK, LLC | 825370300 - (IL) VASCULAR ACCESS CENTERS OF ILLINOIS AT MORGAN PARK LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55875 | $4781.00 | 1356704027 - GLEN ECHO SURGERY CENTER, LLC | 474049838 - (MD) GLEN ECHO SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55875 | $6438.00 | 1114291440 - PREMIER ASC LLC, PREMIER ORTHOPAEDIC SURGERY CENTER | 352433859 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55875 | $1485.00 | 1255303517 - ST DOMINIC AMBULATORY SURGERY CENTER L L C | 640908713 - (MS) ST DOMINIC AMBULATORY SURGERY CENTER L L C | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55875 | $1717.00 | 1114990231 - SURGERY CENTER OF MIDDLE TENNESSEE LLC, THE SURGERY CENTER OF MIDDLE TENNESSEE | 621839266 - (TN) SURGERY CENTER OF MIDDLE TENNESSEE LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55875 | $4790.00 | 1316082365 - WEST WILSHIRE MEDICAL SURGICAL CENTER INC. | 954421811 - (CA) WEST WILSHIRE MEDICAL SURGICAL C | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55875 | $1618.00 | 1225286354 - ASC DEVELOPMENT COMPANY, LLC | 203405773 - (MD) ASC DEVELOPMENT COMPANY 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 55875 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 55875 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 55875 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 |
|---|---|---|
| 55870-CPT | Moderate | Electroejaculation |
| 55873-CPT | High | Cryosurgical Ablation Of The Prostate (Includes Ultrasonic Guidance For Interstitial Cryosurgical Probe Placement) |
| 55874-CPT | High | Transperineal Placement Of Biodegradable Material Peri-Prostatic Single Or Multiple Injection(S) Including Image Guidance When Performed |
| 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 55875. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 55875 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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