CPT 55920 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 • Reproductive System Procedures |
| Common Place of Service | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • AG - Primary physician • UB |
| Complexity Level | Moderate |
| CMS | $451.23 Physician Fee Schedule |
National average reimbursement for CPT 55920 by major payers:
$561.39
$595.76
$639.28
$773.48
| 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 55920 | ||||||
United | 55920 | $847.00 | 1396738936 - WARREN GASTRO ENDOSCOPY CTR INC | 341850936 - (OH) WARREN GASTRO ENDOSCOPY CTR INC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55920 | $3500.00 | 1891253035 - ADVANCED CENTER FOR SURGERY, THE ADVANCED CENTER FOR SURGERY | 611917634 - (FL) ADVANCED CENTER FOR SURGERY | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55920 | $2566.00 | 1952363368 - GOLDEN TRIANGLE SURGICENTER LP | 330529450 - (CA) GOLDEN TRIANGLE SURGICENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55920 | $987.00 | 1629675285 - ORTHOARKANSAS SPINE INSTITUTE PROCEDURE CENTER LLC | 852741945 - (AR) ORTHOARKANSAS SPINE INSTITUTE PROCEDURE CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55920 | $1451.00 | 1366422370 - URLOGY AMBULATORY SURGERY CENTER LLC, WOLF RIVER SURGERY CENTER | 621828958 - (TN) URLOGY AMBULATORY SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55920 | $2300.00 | 1841325214 - AMBULATORY CENTER FOR AESTHETIC AND RECONSTRUCTIVE SURGERY | 208422547 - (MD) AMBULATORY CENTER FOR AESTHETIC AND RECONSTRUCTIVE SURGERY | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55920 | $683.00 | 1609968478 - IOWA ENDOSCOPY CENTER, INC. | 421407285 - (IA) IOWA ENDOSCOPY CENTER INC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55920 | $4277.00 | 1346468253 - FAIRVIEW MAPLE GROVE SURGERY CENTER, LLC | 208335586 - (MN) FAIRVIEW MAPLE GROVE SURGERY CENTER LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55920 | $865.00 | 1275639023 - SURGICAL CENTER OF BURLINGTON COUNTY, INC | 202116181 - (NJ) SURGICAL CENTER OF BURLINGTON COUNTY INC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55920 | $2600.00 | 1255345229 - BEACON ORTHOPAEDICS SURGERY CENTER, LLC, SUMMIT SURGERY CENTER | 311800570 - (OH) BEACON ORTHOPAEDICS SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55920 | $3305.00 | 1992497762 - SEATTLE SURGERY CENTER LLC | 882819593 | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55920 | $1000.00 | 1255792453 - MIDWEST EYE CONSULTANTS OHIO, INC, CATARACT & LASER INSTITUTE #351 | 300888250 - (OH) MIDWEST EYE CONSULTANTS OHIO INC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55920 | $2071.00 | 1417286428 - ALLIANCE SURGICAL CENTER LLC | 271367127 - (FL) ALLIANCE SURGICAL CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55920 | $2148.00 | 1366884322 - INNOVATIONS SURGERY CENTER, PC | 461513141 - (MD) INNOVATIONS SURGERY CENTER PC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55920 | $1410.00 | 1225075435 - SOUTHWESTERN EYE CENTER LTD, SOUTHWESTERN EYE SURGICENTER-COTTONWOOD | 860423068 - SOUTHWESTERN EYE CENTER, LTD. | AZ | 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 55920 vs. Other Reproductive System Procedures Codes
The CPT 55920 code is part of the Surgery services used for Reproductive System Procedures. 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 55920 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 |
|---|---|---|
| 55866-CPT | High | Laparoscopy, Surgical Prostatectomy, Retropubic Radical, Including Nerve Sparing, Includes Robotic Assistance, When Performed |
| 55875-CPT | Moderate | Transperineal Placement Of Needles Or Catheters Into Prostate For Interstitial Radioelement Application With Or Without Cystocopy |
| 55876-CPT | Low | Placement Of Interstitial Device(S) For Radiation Therapy Guidance (Eg, Fiducial Markers, Dosimeter), Prostate (Via Needle, Any Approach), Single Or Multiple (Revision 2011) |
| 55920-CPT | Moderate | Placement Of Needles Or Catheters Into Pelvic Organs And/Or Genitalia (Except Prostate) For Subsequent Interstitial Radioelement Application |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 55920. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 55920 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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