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 |
| Medicare Fee Schedule | View Medicare rates for 55920 |
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 | $1853.00 | 1194275230 - WEST SUBURBAN EYE SURGERY CENTER LLC, SURGISITE NORTH | 201671234 - (MA) WEST SUBURBAN EYE SURGERY CENTER, LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
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 | $1156.00 | 1043625221 - INTERVENTIONAL SURGERY INSTITUTE OF LITTLE ROCK, LLC, INTERVENTIONAL SURGERY INSTITUTE | 471050942 - (AR) INTERVENTIONAL SURGERY INSTITUTE OF LITTLE ROCK LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55920 | $1387.00 | 1780117440 - INSIGHT SURGERY CENTER, LLC | 813772336 - (CO) INSIGHT SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55920 | $1720.00 | 1508846122 - HEALTH & WELLNESS SURGERY CENTER, TOWER SURGERY CENTER | 562437008 - (CA) HEALTH WELLNESS SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55920 | $2858.00 | 1548226442 - ARTHROSCOPIC & LASER SURGERY CENTER OF SAN DIEGO LP | 631166884 - (CA) ARTHROSCOPIC & LASER SURGERY CENTER OF SAN DIEGO, LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55920 | $2910.00 | 1477242154 - PLYMOUTH ORTHOPEDIC SURGERY CENTER LLC, PLYMOUTH ORTHOPEDIC SURGERY CENTER | 883632673 - (MN) PLYMOUTH ORTHOPEDIC 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 | $3570.00 | 1548217128 - GULFSHORE ENDOSCOPY CENTER LLC | 650615196 - (FL) GULFSHORE ENDOSCOPY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55920 | $1200.00 | 1043205040 - ST LUKES SURGICAL CENTER INC | 592407224 - (FL) ST LUKES SURGICAL CENTER INC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55920 | $4192.00 | 1902959190 - RIVA ROAD SURGICAL CENTER, LLC | 870774597 - (MD) RIVA ROAD SURGICAL CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55920 | $853.00 | 1659525020 - GLASTONBURY ENDOSCOPY CENTER, LLC | 261721234 - (CT) GLASTONBURY ENDOSCOPY CENTER LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55920 | $7210.00 | 1336294859 - LOS ROBLES SURGICENTER, LLC, LOS ROBLES SURGICENTER | 770216847 - (CA) LOS ROBLES SURGICENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55920 | $2435.00 | 1508135658 - SURGERY CENTER OF ATHENS LLC | 450581955 - (GA) SURGERY CENTER OF ATHENS LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55920 | $3201.00 | 1669787958 - PINE RIDGE SURGERY CENTER, LLC | 271609169 - (WI) PINE RIDGE SURGERY CENTER, LLC | WI | 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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