FeeBase
Log inGet started
Menu

Billing code 55868: ProstatectomyMedicare rate & RVUs

Reports laparoscopic radical prostate removal with lymph node biopsy, including robotic assistance when performed, for a documented operative approach and nodal sampling.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,107.57 for 55868 nationally in a facility.

Medicare rate · 55868

Prostatectomy

Swap in your local Medicare rate.

Work RVUs
22.46
Total RVUs
33.16
Global days
090

National rate · 2026

$1,107.57

Facility setting, before claim adjustments.

See every locality for 55868 → · 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 55868 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 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

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

109 of 109 payment localities

55868 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,032.87
Alaska*Unavailable$1,455.94
ArizonaUnavailable$1,085.51
ArkansasUnavailable$1,023.75
AtlantaUnavailable$1,133.52
AustinUnavailable$1,113.08
BakersfieldUnavailable$1,108.80
Baltimore/Surr. CntysUnavailable$1,161.61
BeaumontUnavailable$1,077.26
BrazoriaUnavailable$1,089.85

55868 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

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
55868 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 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

Swap in your local Medicare rate.

Work 22.46Practice expense 7.79Malpractice 2.91

33.1600 adjusted RVUs×$33.4009 conversion factor=$1,107.57

All indexes start 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

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)0The 150% bilateral adjustment doesn’t apply.
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)0.08/0.83/0.09Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 55868

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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

55868 without 51 · national facility

$1,107.57

Prostatectomy

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%).

When to use modifier 51

55868 compared with similar codes

Compare codes

55868 vs 55866 vs 55869 vs 55845: national Medicare rates

Swap in your local Medicare rate.

  • 55868
    Prostatectomy · 22.46 wRVU
    —
  • 55866
    Prostatectomy · 21.9 wRVU
    —
  • 55869
    Prostatectomy · 27.41 wRVU
    —
  • 55845
    Radical prostatectomy · 24.55 wRVU
    —

How to choose

55866Prostatectomy
Choose 55868 when lymph node biopsy accompanies the laparoscopic radical prostatectomy; 55866 is for the laparoscopic radical prostatectomy without that biopsy.
55869Prostatectomy
55869 represents laparoscopic radical prostatectomy with bilateral pelvic lymphadenectomy. 55868 represents lymph node biopsy rather than that bilateral dissection.
55845Radical prostatectomy
Both involve radical prostatectomy and bilateral pelvic nodal surgery, but 55845 is the open approach; 55868 is laparoscopic and describes lymph node biopsy.

Codes related to 55868

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

Codes related to 55868
CodeHow it relatesNational office range
Used instead
55866ProstatectomyLaparoscopic radical prostatectomy without the lymph node biopsy described by 55868.No office rate
55845Radical prostatectomyOpen radical prostatectomy with bilateral pelvic lymphadenectomy.No office rate
55840Radical prostatectomyOpen retropubic radical prostatectomy, rather than the laparoscopic approach.No office rate
Same family
55869ProstatectomyLaparoscopic radical prostatectomy with bilateral pelvic lymphadenectomy rather than lymph node biopsy.No office rate

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

Show the CMS file lines behind this rate
RVUs for 55868PPRRVU2026_Oct_nonQPP.csv, line 6,388 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 55868 pays?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets

Put 55868 and the rest of your codes on one sheet

Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.

Build my fee sheetOr price your code list free →