Billing code 55867: ProstatectomyMedicare rate & RVUs

Medicare pays $945.91 for 55867 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 55867 covers

A urologist uses a laparoscopic approach to remove obstructing adenomatous prostate tissue while leaving the prostate capsule and surrounding structures. This simple, subtotal operation is used for conditions such as benign prostatic enlargement with substantial urinary obstruction; it is distinct from removal of the prostate and surrounding tissue as a radical cancer operation. The service is generally performed in an operating room at a hospital or ambulatory surgery facility.

Report the code when the operative documentation supports laparoscopic access and a simple subtotal prostatectomy. The note should identify the approach and the extent and purpose of prostate tissue removal, distinguishing it from a radical procedure or a different surgical route. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Assistant-at-surgery payment may be allowed; co-surgeon payment requires supporting documentation. Team surgery is not permitted, and modifier 50 is inappropriate.

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 55867 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

55867 rates by state

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

How the 55867 rate is calculated

Each of 55867’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 55867

55867 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

55867 compared with similar codes

How to choose

55866Prostatectomy

55866 describes laparoscopic radical prostatectomy. Choose 55867 for simple subtotal removal of obstructing tissue, not a radical cancer operation.

55821Prostatectomy

Both describe simple subtotal prostatectomy, but 55821 uses a retropubic approach; 55867 is laparoscopic.

55831Prostatectomy

55831 is the perineal approach to simple subtotal prostatectomy. Use 55867 when the documented approach is laparoscopic.

55868Prostatectomy

55868 is the related laparoscopic prostatectomy code involving lymph node biopsy; 55867 describes the simple subtotal procedure without that distinction.

Codes related to 55867

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