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Billing code 55869: ProstatectomyMedicare rate & RVUs

Reports laparoscopic radical prostate removal with bilateral pelvic lymphadenectomy, typically performed by a urologist for prostate cancer.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,328.69 for 55869 nationally in a facility.

Medicare rate · 55869

Prostatectomy

Swap in your local Medicare rate.

Work RVUs
27.41
Total RVUs
39.78
Global days
090

National rate · 2026

$1,328.69

Facility setting, before claim adjustments.

See every locality for 55869 → · 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 55869 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 55869 covers

A urologist performs this laparoscopic operation to remove the prostate and dissect lymph nodes on both sides of the pelvis. It is used in the surgical treatment of prostate cancer and is generally performed in an operating room. The operative report should establish that the prostatectomy was radical and that bilateral pelvic lymphadenectomy was performed; node sampling by biopsy alone is a different service.

Report this code for the combined laparoscopic procedure, rather than for a prostatectomy without the specified bilateral lymphadenectomy. CMS assigns a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; 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 55869 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

55869 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,240.40
Alaska*Unavailable$1,752.36
ArizonaUnavailable$1,302.48
ArkansasUnavailable$1,229.64
AtlantaUnavailable$1,359.98
AustinUnavailable$1,334.09
BakersfieldUnavailable$1,328.00
Baltimore/Surr. CntysUnavailable$1,392.94
BeaumontUnavailable$1,293.76
BrazoriaUnavailable$1,307.27

55869 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
55869 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 55869 rate is calculated

Each of 55869’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 · 55869

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 27.41Practice expense 8.82Malpractice 3.55

39.7800 adjusted RVUs×$33.4009 conversion factor=$1,328.69

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 55869

55869 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 55869

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 · 55869

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

55869 without 51 · national facility

$1,328.69

Prostatectomy

55869-51 · Second procedure: 50%

$664.35

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

55869 compared with similar codes

Compare codes

55869 vs 55866 vs 55868 vs 55845 vs 55867: national Medicare rates

Swap in your local Medicare rate.

  • 55869
    Prostatectomy · 27.41 wRVU
    —
  • 55866
    Prostatectomy · 21.9 wRVU
    —
  • 55868
    Prostatectomy · 22.46 wRVU
    —
  • 55845
    Radical prostatectomy · 24.55 wRVU
    —
  • 55867
    Prostatectomy · 19.04 wRVU
    —

How to choose

55866Prostatectomy
Choose 55869 when the laparoscopic radical prostatectomy includes bilateral pelvic lymphadenectomy. Code 55866 describes the laparoscopic radical prostatectomy without that specified lymphadenectomy.
55868Prostatectomy
55868 identifies laparoscopic prostatectomy with pelvic lymph node biopsy. This code identifies the operation with bilateral pelvic lymphadenectomy.
55845Radical prostatectomy
Both describe radical prostatectomy with bilateral pelvic lymphadenectomy, but 55845 is the open operation and this code is laparoscopic.
55867Prostatectomy
55867 describes laparoscopic simple subtotal prostatectomy. This code is for a radical prostatectomy with bilateral pelvic lymphadenectomy.

Codes related to 55869

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

Codes related to 55869
CodeHow it relatesNational office range
Used instead
55866ProstatectomyLaparoscopic radical prostatectomy when bilateral pelvic lymphadenectomy is not part of the reported service.No office rate
55868ProstatectomyRelated laparoscopic prostatectomy code specifying pelvic lymph node biopsy rather than bilateral lymphadenectomy.No office rate
55845Radical prostatectomyOpen radical prostatectomy with bilateral pelvic lymphadenectomy, rather than the laparoscopic approach.No office rate
55867ProstatectomyLaparoscopic simple subtotal prostatectomy, a different extent of prostate removal.No office rate

55869 billing questions

How does this differ from 55866?

This code describes laparoscopic radical prostatectomy with bilateral pelvic lymphadenectomy. Code 55866 describes the laparoscopic radical prostatectomy without that bilateral lymphadenectomy specified.

Is bilateral lymphadenectomy included in this service?

Yes. Bilateral pelvic lymphadenectomy is part of the combined service represented by this code; the operative report should document the dissection.

Should modifier 50 be appended?

No. CMS identifies bilateral adjustment as inappropriate for this code because the descriptor or anatomy already accounts for the bilateral service.

What global period applies?

The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care.

Can an assistant or co-surgeon be reported?

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

How are other same-session procedures paid?

Under the standard multiple-procedure rule, the highest-valued procedure is paid in full and other procedures performed in the same session are subject to a reduction.

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 55869PPRRVU2026_Oct_nonQPP.csv, line 6,389 (RVU26D)

Open CMS sourceHow we calculate rates

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