CPT code 55821: Prostatectomy, suprapubic subtotal2026 Medicare rate & RVUs

Medicare pays $755.19 for 55821 nationally in a facility.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 55821 covers

A urologist performs this open operation through a lower abdominal incision and an opening into the bladder to remove the obstructing portion of the prostate. It is generally used for substantial benign prostatic enlargement, such as when urinary obstruction requires surgical treatment. The prostate capsule remains, distinguishing this subtotal operation from radical prostatectomy for cancer. The procedure is typically performed in a hospital operating room.

Select the code when the operative report supports the suprapubic route and subtotal removal, rather than a perineal or retropubic approach or radical cancer surgery. The report should identify the approach, extent of removal, and indication. Associated services specified as included in the code, such as cystourethroscopy, urethral dilation, or control of postoperative bleeding, are not separately reported as components of this operation. It has a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 55821 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

55821 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 55821 rate is calculated

Each of 55821’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 55821

55821 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

55821 compared with similar codes

How to choose

55801ProstatectomyPerineal, subtotal

Both are subtotal prostatectomies; choose 55801 for the perineal route and 55821 for the suprapubic route through the bladder.

55831ProstatectomyRetropubic, subtotal

This is the retropubic subtotal approach. Code 55821 describes the suprapubic approach.

55840Radical prostatectomyRetropubic approach

This code describes retropubic radical prostatectomy, a different extent of surgery. Code 55821 is subtotal removal for conditions such as benign enlargement.

52601TURPElectrosurgical resection

This code represents transurethral prostate resection, not open suprapubic subtotal prostate removal.

Codes related to 55821

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates