CPT code 55868: Prostatectomy, with lymph node biopsy2026 Medicare rate & RVUs in Missouri
Reports laparoscopic radical prostate removal with lymph node biopsy, including robotic assistance when performed, for a documented operative approach and nodal sampling.
CMS doesn’t publish an office rate for 55868 in Missouri.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 55868 covers
A urologist performs this laparoscopic operation to remove the prostate radically and biopsy lymph nodes during the same procedure, commonly in surgical treatment of prostate cancer. The approach may be conventional laparoscopy or robot-assisted; robotic assistance is part of the laparoscopic service when used. The operative report should identify the prostatectomy and the lymph node biopsy performed.
Select this code when the procedure includes lymph node biopsy; use the code for bilateral pelvic lymphadenectomy when that broader nodal procedure is performed instead. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; 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 55868 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | $1,089.47 |
| Metropolitan St. Louis, MO | Unavailable | $1,095.28 |
| Rest of Missouri | Unavailable | $1,069.14 |
How the 55868 rate is calculated
Each of 55868’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.
How the rate is built · 55868
RVUs × geographic indexes × conversion factor
Work22.46
22.46 RVUs× 1.000 GPCI
Practice expense7.79
7.79 RVUs× 1.000 GPCI
Malpractice2.91
2.91 RVUs× 1.000 GPCI
Adjusted RVUs
33.1600
Conversion factor
$33.4009
Medicare rate
$1,107.57
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 55868
55868 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 55868
Prostatectomy, with lymph node biopsy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.08/0.83/0.09 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 55868
Prostatectomy, with lymph node biopsy
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
55868 without 51 · national facility
$1,107.57
Prostatectomy, with lymph node biopsy
55868-51 · Second procedure: 50%
$553.79
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
55868 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 55866ProstatectomyLaparoscopic, radical
- Choose 55868 when lymph node biopsy accompanies the laparoscopic radical prostatectomy; 55866 is for the laparoscopic radical prostatectomy without that biopsy.
- 55869ProstatectomyBilateral pelvic lymphadenectomy
- 55869 represents laparoscopic radical prostatectomy with bilateral pelvic lymphadenectomy. 55868 represents lymph node biopsy rather than that bilateral dissection.
- 55845Radical prostatectomyRetropubic, extensive node dissection
- Both involve radical prostatectomy and bilateral pelvic nodal surgery, but 55845 is the open approach; 55868 is laparoscopic and describes lymph node biopsy.
55868 billing questions
How does this differ from 55866?
Use 55868 when the laparoscopic radical prostatectomy includes lymph node biopsy. Code 55866 describes the laparoscopic radical prostatectomy without that biopsy.
When is 55869 a better fit?
Use 55869 for the laparoscopic radical prostatectomy with bilateral pelvic lymphadenectomy. This code is for lymph node biopsy, not that broader bilateral dissection.
Should modifier 50 be appended for lymph node work on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; do not use modifier 50.
Is robotic assistance reported separately?
No. Robotic assistance, when performed, is included in the laparoscopic prostatectomy service.
What documentation supports reporting this code?
The operative report should establish the laparoscopic radical prostatectomy and the lymph node biopsy performed. It should distinguish biopsy from bilateral pelvic lymphadenectomy.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, with other procedures subject to the standard multiple-procedure reduction. Related postoperative care is included in the 90-day global period.
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
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