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Billing code 55865: ProstatectomyMedicare rate & RVUs

Reports laparoscopic radical removal of the prostate with bilateral pelvic lymph node dissection, including nerve-sparing work when performed.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,191.08 for 55865 nationally in a facility.

Medicare rate · 55865

Prostatectomy

Work RVUs
23.96
Total RVUs
35.66
Global days
090

National rate · 2026

$1,191.08

Facility setting, before claim adjustments.

See every locality for 55865 →Billed by an NP, PA or therapist? →

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

On this page 10 sections
  1. Medicare rate
  2. What 55865 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 55865 covers

A urologist performs this laparoscopic operation to remove the prostate and dissect pelvic lymph nodes on both sides, including the external iliac, hypogastric, and obturator nodal groups. Nerve-sparing may be performed when clinically feasible. It is typically used for prostate cancer and performed in a hospital operating room; robotic assistance may be used as part of the laparoscopic approach.

Choose this code when the operative report supports both radical prostate removal and bilateral pelvic lymphadenectomy. Document the approach, extent of prostate removal, nodal regions dissected, and any nerve-sparing work. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. The service is priced as bilateral, so modifier 50 does not increase payment. 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 55865 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

55865 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,110.65
Alaska*Unavailable$1,564.09
ArizonaUnavailable$1,167.41
ArkansasUnavailable$1,100.82
AtlantaUnavailable$1,218.64
AustinUnavailable$1,197.76
BakersfieldUnavailable$1,194.02
Baltimore/Surr. CntysUnavailable$1,249.17
BeaumontUnavailable$1,157.85
BrazoriaUnavailable$1,172.40

55865 rates by state

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

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
55865 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 55865 rate is calculated

Each of 55865’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 · 55865

RVUs × geographic indexes × conversion factor

Work23.96

23.96 RVUs× 1.000 GPCI

Practice expense8.64

8.64 RVUs× 1.000 GPCI

Malpractice3.06

3.06 RVUs× 1.000 GPCI

Adjusted RVUs

35.6600

Conversion factor

$33.4009

Medicare rate

$1,191.08

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 55865

55865 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 55865

Prostatectomy

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)2Already bilateral by definition: paid once at 100%.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.80/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 55865

Prostatectomy

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

55865 without 51 · national facility

$1,191.08

Prostatectomy

55865-51 · Second procedure: 50%

$595.54

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%).

When to use modifier 51

55865 compared with similar codes

Compare codes · National

4 codes, side by side

  • 55865

    Prostatectomy23.96 wRVU

    Not priced

  • 55866

    Prostatectomy21.9 wRVU

    Not priced

  • 55845

    Radical prostatectomy24.55 wRVU

    Not priced

  • 55842

    Radical prostatectomy20.83 wRVU

    Not priced

How to choose

55866Prostatectomy
Both describe laparoscopic radical prostatectomy, but 55865 includes bilateral pelvic lymphadenectomy; 55866 is used when that dissection is not performed.
55845Radical prostatectomy
This is the open retropubic approach with bilateral pelvic lymphadenectomy. Use 55865 for the laparoscopic approach.
55842Radical prostatectomy
This is an open radical prostatectomy with limited lymph node biopsy, not the laparoscopic procedure with bilateral pelvic lymphadenectomy.

Codes related to 55865

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

Codes related to 55865
CodeHow it relatesNational office range
Used instead
55866ProstatectomyLaparoscopic radical prostatectomy without the bilateral pelvic lymphadenectomy included in 55865.No office rate
55845Radical prostatectomyOpen retropubic radical prostatectomy with bilateral pelvic lymphadenectomy.No office rate
55842Radical prostatectomyOpen retropubic radical prostatectomy with limited lymph node biopsy rather than bilateral lymphadenectomy.No office rate
55840Radical prostatectomyOpen retropubic radical prostatectomy without the bilateral pelvic lymphadenectomy included in 55865.No office rate

55865 billing questions

How does this differ from 55866?

55865 includes bilateral pelvic lymphadenectomy with the laparoscopic radical prostatectomy. Use 55866 when the laparoscopic radical prostatectomy is performed without that bilateral node dissection.

Should modifier 50 be appended for the bilateral node dissection?

The code is already priced as bilateral, and modifier 50 does not increase payment.

Is the pelvic lymphadenectomy included?

Yes. The code covers the bilateral dissection of the specified pelvic nodal groups as part of the laparoscopic radical prostatectomy.

What documentation supports reporting 55865?

The operative report should establish the laparoscopic approach, radical prostate removal, and bilateral dissection of pelvic nodes, identifying the nodal regions addressed.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team surgery is not permitted.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days.

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

Show the CMS file lines behind this rate
RVUs for 55865PPRRVU2026_Oct_nonQPP.csv, line 6,385 (RVU26D)

Open CMS sourceHow we calculate rates

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