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 |
| Medicare Fee Schedule | View Medicare rates for 55875 |
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 | $4010.00 | 1447355243 - SURGICENTER OF GREATER MILWAUKEE, LLC, SURGICENTER OF GREATER MILWAUKEE, INC. | 391682308 - (WI) CHILDREN'S HOSPITAL AND HEALTH SYSTEM, INC. | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55875 | $4840.00 | 1457960536 - LAKE GEORGE SURGERY CENTER, LLC | 844411548 - (IN) LAKE GEORGE SURGERY CENTER, LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55875 | $5601.00 | 1720011042 - PREMIER ORTHOPAEDIC SURGERY CENTER, LLC | 352433859 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55875 | $2790.00 | 1760465207 - PLASTIC SURGICAL CENTER OF RAPID CITY, PROF. L.L.C. | 460441899 - (SD) PLASTIC SURGICAL CENTER OF RAPID CITY PROF LLC | SD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55875 | $5354.00 | 1750363461 - BARKLEY SURGICENTER, LLC | 650428622 - (FL) BARKLEY SURGICENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55875 | $2861.00 | 1760931349 - SF NASSAU ASC LLC | 300870382 - (NY) SF NASSAU ASC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55875 | $4601.00 | 1457379158 - HUDSON CROSSING SURGERY CENTER, LLC, HUDSON CROSSING SURGERY CENTER | 364533553 - (NJ) HUDSON CROSSING SURGICAL CENTER | NJ | 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 | $713.00 | 1194492546 - BARNET DULANEY PERKINS EYE CENTER, PC, AMERICAN VISION PARTNERS | 562589722 - BARNET DULANEY PERKINS EYE CENTER PLLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55875 | $1500.00 | 1851407373 - RIVERSIDE AMBULATORY SURGERY CENTER, LLC | 320082320 - (IL) RIVERSIDE AMBULATORY SURGERY CENTER, LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55875 | $2011.00 | 1386618783 - LEWES DE ENDOSCOPY ASC LLC, SEASIDE ENDOSCOPY PAVILION | 562299727 - (DE) LEWES DE ENDOSCOPY ASC LLC | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55875 | $1000.00 | 1841259611 - ALTA-ROSE SURGERY CENTER LLC | 201429557 | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55875 | $2090.00 | 1184689408 - EVERGREEN EYE CENTER, PLLC, EYE ASSOCIATES NORTHWEST SURGERY CENTER | 911610832 - (WA) EYE ASSOCIATES NORTHWEST, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55875 | $963.00 | 1083638647 - WEST DES MOINES AMBULATORY SURGICAL CENTER LLC, WESTOWN AMBULATORY CENTER | 421469883 - (IA) WEST DES MOINES AMBULATORY SURGICAL CENTER LLC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55875 | $7635.00 | 1285912600 - THE EMORY CLINIC INC, THE EMORY CLINIC LAGRANGE SURGERY CENTER | 582030692 - EMORY UNIVERSITY | GA | 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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