How do Medicare & Medicaid Rates affect fee schedules?

Medicare & Medicaid Rates are government-set reimbursement amounts that influence fee schedules.

How does Geographic Location affect fee schedules?

Geographic Location can affect fee schedules, with costs often being higher in urban areas compared to rural ones.

How does Provider Type affect fee schedules?

Provider Type, such as hospital providers versus private practice, can lead to different rates within fee schedules.

A CPT (Current Procedural Terminology) code is a five-digit numerical code used by medical professionals to report medical, surgical, and diagnostic services and procedures. These codes standardize the language used to describe medical services, facilitating accurate billing and record-keeping across the healthcare system.

What is a fee schedule in healthcare?

A fee schedule is a comprehensive listing of fees used by health insurers and government programs (like Medicare and Medicaid) to pay providers for healthcare services and procedures. It specifies the maximum amount that will be paid for each CPT code, often varying by location and the type of provider.

How can I find the cost of a specific medical procedure or service?

To find the cost of a specific medical procedure or service, you'll generally need the CPT code for that service and your specific location. For accurate and up-to-date pricing information based on your CPT code and location, you can use tools like Payerprice. Payerprice offers a fee schedule lookup tool that allows users to search with a CPT code and specific location to understand potential costs.

What is the role of CMS in healthcare pricing?

CMS (Centers for Medicare & Medicaid Services) is a federal agency that administers the Medicare program and works with states to administer Medicaid and the Children's Health Insurance Program (CHIP). CMS establishes national standards and payment methodologies for these programs, including setting fee schedules and reimbursement rates for a vast array of medical services, which often influence private payer rates as well.

How is Payerprice different from CMS for looking up prices?

While CMS provides extensive public data regarding Medicare and Medicaid reimbursement rates, navigating this information for specific CPT codes and locations can be complex for the average user. Payerprice offers a user-friendly fee schedule lookup tool specifically designed for individuals to easily search for pricing based on CPT codes and specific locations, often covering a broader range of payers beyond just government programs and presenting the information in an accessible format. It streamlines the process of understanding potential costs for specific procedures.

Why do medical costs vary so much?

Medical costs can vary significantly due to a multitude of factors, including geographic location, the specific healthcare facility (e.g., hospital vs. outpatient clinic), the provider's experience and specialty, insurance negotiation power, the complexity of the procedure, and the type of insurance plan. These variations highlight the importance of researching costs for specific procedures in your area using tools like Payerprice.

CPT 55876 Fee Schedule

Q: How do Private Insurance Rates affect fee schedules?

Private Insurance Rates are negotiated rates between providers and insurance companies, which are a major factor in fee schedules.

Last Verified: October 2026

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.

Place Radiation Therapy Guide, Insertion Of One Or More Radiation Therapy Guidance Devices. The Devices Guide Regulate Or Deliver Radiation Therapy To A Specific Place Inside The Body. Insertion May Be Done By Puncturing The Skin Or During Surgery.

Key Fact	Detail
Service Type	Surgery Surgical Procedures on the Male Genital System
Common Place of Service	11 - Office 22 - On Campus Outpatient Hospital
Common Modifiers	None 51 - Multiple procedures 59 - Distinct Procedural Service
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 55876
Medicaid Fee Schedule	View Medicaid rates for 55876

National average reimbursement for CPT 55876 by major payers:

$180.98

$190.21

$210.22

$182.77

Compare published rates across providers.

Choose a payer to see a sample of rates for CPT 55876.

CPT 55876

5 of 25 sample ratesHigher to lower in this preview

Ssm St Clare Surgical Center LLC, Ssm St Clare Surgical Center
Ssm St Clare Surgical Center LLC
MOAmbulatory Surgical Clinic/CenterNPI 1033351119Tax ID 26-1439695
$16,647.00Published rate
La Peer Surgery Center, LLC, La Peer Health Systems
Lapeer Surgery Center, LLC
CAAmbulatory Surgical Clinic/CenterNPI 1932214624Tax ID 20-2788594
$1,000.00Published rate
San Diego Ca Multi Specialty Asc LLC, Mission Valley Heights Surgery Center
Poway Ca Multi-Specialty Asc LLC
CAAmbulatory Surgical Clinic/CenterNPI 1699959387Tax ID 26-1158246
$650.00Published rate
San Luis Walk-In Clinic, Inc., San Luis Outpatient Surgery Center
San Luis Walk-In Clinic Inc
AZAmbulatory Surgical Clinic/CenterNPI 1114549987Tax ID 65-1170616
$600.00Published rate
Lakeforest Ambulatory Surgery Center, District Heights Ambulatory Surgery Center
Lakeforest Ambulatory Surgery Center
MDAmbulatory Surgical Clinic/CenterNPI 1487779435Tax ID 52-1944179
$323.00Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

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CPT 55876 vs. Other Surgical Procedures on the Male Genital System Codes

The CPT 55876 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 55876 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
55873-CPT	High	Prostate Surgery, Surgery Aided By Ultrasound (Image Made With Sound Waves) To Freeze The Prostate Gland. This Is A Minimally Invasive Procedure That Does Not Remove The Prostate Gland.
55874-CPT	High	Transperineal Placement Of Bio, Transperineal Placement Of Biodegradable Materialperi-Prostatic Single Or Multiple Injection(S) Including Image Guidance When Performed Ainage Procedure If Performed With Open Cervical Pharyngogastrostomy Or Esophagogastrostomy (Ie Th
55875-CPT	Moderate	Inject X-Ray Dye In Prostate, Placement Of Needles Or Catheters (Thin Tubes) Into The Prostate. These Will Carry A Contrast Solution (Saline Dye) To Aid An Imaging Procedure.
55876-CPT	Low	Place Radiation Therapy Guide, Insertion Of One Or More Radiation Therapy Guidance Devices. The Devices Guide Regulate Or Deliver Radiation Therapy To A Specific Place Inside The Body. Insertion May Be Done By Puncturing The Skin Or During Surgery.

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 55876. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 55876 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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CPT 55876 Fee Schedule

Compare published rates across providers.

Ssm St Clare Surgical Center LLC, Ssm St Clare Surgical Center

La Peer Surgery Center, LLC, La Peer Health Systems

San Diego Ca Multi Specialty Asc LLC, Mission Valley Heights Surgery Center

San Luis Walk-In Clinic, Inc., San Luis Outpatient Surgery Center

Lakeforest Ambulatory Surgery Center, District Heights Ambulatory Surgery Center