Billing code 55874: Prostate spacerMedicare rate & RVUs
Reports transperineal placement of biodegradable material around the prostate, commonly before radiation therapy to increase separation between the prostate and rectum.
Medicare pays $3,704.49 for 55874 nationally in the office and $142.62 in a hospital or facility. Local office rates run $3,192.26–$5,299.18.
Medicare rate · 55874
Prostate spacer
- Work RVUs
- 2.95
- Total RVUs
- 110.91
- Global days
- 000
National rate · 2026
$3,704.49
Office setting, before claim adjustments.
See every locality for 55874 →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
What 55874 covers
A urologist typically places biodegradable material, often a hydrogel spacer, in the tissue plane between the prostate and rectum before prostate radiation therapy. The added separation can help limit radiation exposure to the rectum. Placement is performed through the perineum with image guidance, commonly in an outpatient or hospital setting. The service may involve one or multiple deposits of material during the procedure.
Report 55874 for the spacer placement, including image guidance when performed; the code covers single or multiple placements in the session. The record should support the indication, transperineal placement, material used, and procedural details. It has a 0-day global period, so same-day preoperative and postoperative care is included. For procedures in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery; co-surgeon or team-surgery payment requires supporting documentation.
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 55874 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$3192.26 to $5299.18
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $3,250.34 | $133.70 |
| Alaska* | $3,982.48 | $189.09 |
| Arizona | $3,591.46 | $140.01 |
| Arkansas | $3,192.26 | $132.61 |
| Atlanta | $3,764.52 | $145.66 |
| Austin | $3,911.94 | $143.48 |
| Bakersfield | $4,047.17 | $143.36 |
| Baltimore/Surr. Cntys | $3,971.11 | $149.22 |
| Beaumont | $3,380.17 | $138.86 |
| Brazoria | $3,670.50 | $140.69 |
| Chicago | $3,737.43 | $157.75 |
| Chico | $4,046.17 | $142.36 |
| Colorado | $3,933.34 | $143.51 |
| Connecticut | $3,985.59 | $149.45 |
| Dallas | $3,689.44 | $141.81 |
| Dc + Md/Va Suburbs | $4,350.96 | $155.07 |
| Delaware | $3,660.73 | $141.60 |
| Detroit | $3,586.23 | $149.03 |
| East St. Louis | $3,428.08 | $151.15 |
| El Centro | $4,046.22 | $142.41 |
| Fort Lauderdale | $3,760.13 | $151.96 |
| Fort Worth | $3,653.63 | $141.62 |
| Fresno | $4,046.17 | $142.36 |
| Galveston | $3,678.22 | $141.28 |
| Hanford-Corcoran | $4,046.17 | $142.36 |
| Hawaii, Guam | $4,192.36 | $142.51 |
| Houston | $3,684.26 | $147.32 |
| Idaho | $3,411.09 | $134.17 |
| Indiana | $3,436.40 | $134.54 |
| Iowa | $3,392.28 | $133.16 |
| Kansas | $3,353.91 | $133.98 |
| Kentucky | $3,304.52 | $138.01 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $4,362.70 | $149.01 |
| Madera | $4,046.17 | $142.36 |
| Manhattan | $4,299.64 | $160.74 |
| Merced | $4,046.17 | $142.36 |
| Metropolitan Boston | $4,404.74 | $151.86 |
| Metropolitan Kansas City | $3,484.95 | $140.35 |
| Metropolitan Philadelphia | $3,855.79 | $147.88 |
| Metropolitan St. Louis | $3,531.96 | $141.06 |
| Miami | $3,868.74 | $160.83 |
| Minnesota | $3,800.99 | $135.82 |
| Mississippi | $3,201.92 | $135.15 |
| Modesto | $4,046.17 | $142.36 |
| Montana** | $3,704.47 | $142.60 |
| Napa | $4,848.47 | $153.92 |
| Nebraska | $3,420.83 | $133.22 |
| Nevada** | $3,706.25 | $140.81 |
| New Hampshire | $3,850.51 | $142.60 |
| New Mexico | $3,408.33 | $142.09 |
| New Orleans | $3,493.89 | $142.17 |
| North Carolina | $3,459.65 | $136.43 |
| North Dakota** | $3,697.95 | $136.07 |
| Northern Nj | $4,286.64 | $154.87 |
| Nyc Suburbs/Long Island | $4,399.69 | $164.62 |
| Ohio | $3,391.82 | $139.83 |
| Oklahoma | $3,317.38 | $136.63 |
| Oxnard-Thousand Oaks-Ventura | $4,357.38 | $147.24 |
| Portland | $4,102.29 | $145.05 |
| Poughkpsie/N Nyc Suburbs | $4,052.76 | $152.51 |
| Puerto Rico | $3,743.87 | $142.82 |
| Queens | $4,369.95 | $159.82 |
| Redding | $4,046.17 | $142.36 |
| Rest Of California | $4,046.17 | $142.36 |
| Rest Of Florida | $3,551.86 | $146.71 |
| Rest Of Georgia | $3,318.36 | $141.17 |
| Rest Of Illinois | $3,397.94 | $145.95 |
| Rest Of Louisiana | $3,290.61 | $138.36 |
| Rest Of Maine | $3,412.73 | $135.81 |
| Rest Of Maryland | $3,747.71 | $143.10 |
| Rest Of Massachusetts | $3,894.36 | $143.71 |
| Rest Of Michigan | $3,393.16 | $141.17 |
| Rest Of Missouri | $3,208.11 | $137.77 |
| Rest Of New Jersey | $4,040.24 | $150.67 |
| Rest Of New York | $3,521.47 | $137.69 |
| Rest Of Oregon | $3,686.84 | $139.22 |
| Rest Of Pennsylvania | $3,409.10 | $139.30 |
| Rest Of Texas | $3,520.08 | $139.87 |
| Rest Of Washington | $3,893.67 | $143.02 |
| Rhode Island | $3,823.81 | $144.39 |
| Riverside-San Bernardino-Ontario | $4,049.76 | $145.95 |
| Sacramento-Roseville-Folsom | $4,288.90 | $146.44 |
| Salinas | $4,274.03 | $145.82 |
| San Diego-Chula Vista-Carlsbad | $4,407.01 | $147.01 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $5,181.82 | $159.58 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $5,181.44 | $159.20 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $5,299.18 | $162.96 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $5,297.65 | $161.43 |
| San Luis Obispo-Paso Robles | $4,200.75 | $143.78 |
| Santa Cruz-Watsonville | $4,474.36 | $146.69 |
| Santa Maria-Santa Barbara | $4,298.90 | $145.76 |
| Santa Rosa-Petaluma | $4,521.98 | $148.00 |
| Seattle (King Cnty) | $4,523.45 | $153.04 |
| South Carolina | $3,429.63 | $138.46 |
| South Dakota** | $3,697.18 | $135.30 |
| Southern Maine | $3,668.07 | $138.26 |
| Stockton | $4,046.17 | $142.36 |
| Suburban Chicago | $3,810.76 | $152.71 |
| Tennessee | $3,372.25 | $134.51 |
| Utah | $3,487.67 | $139.51 |
| Vallejo | $4,847.93 | $153.38 |
| Vermont | $3,663.10 | $136.85 |
| Virgin Islands | $3,743.87 | $142.82 |
| Virginia | $3,640.14 | $138.82 |
| Visalia | $4,046.17 | $142.36 |
| West Virginia | $3,238.31 | $143.04 |
| Wisconsin | $3,545.88 | $133.61 |
| Wyoming** | $3,701.63 | $139.76 |
| Yuba City | $4,046.17 | $142.36 |
55874 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$3,192.26
$4,672.68
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $3,982.48 | 1 |
| AL | $3,250.34 | 1 |
| AR | $3,192.26 | 1 |
| AZ | $3,591.46 | 1 |
| CA | $4,046.17–$5,299.18 | 29 |
| CO | $3,933.34 | 1 |
| CT | $3,985.59 | 1 |
| DC | $4,350.96 | 1 |
| DE | $3,660.73 | 1 |
| FL | $3,551.86–$3,868.74 | 3 |
| GA | $3,318.36–$3,764.52 | 2 |
| GU | $4,192.36 | 1 |
| HI | $4,192.36 | 1 |
| IA | $3,392.28 | 1 |
| ID | $3,411.09 | 1 |
| IL | $3,397.94–$3,810.76 | 4 |
| IN | $3,436.40 | 1 |
| KS | $3,353.91 | 1 |
| KY | $3,304.52 | 1 |
| LA | $3,290.61–$3,493.89 | 2 |
| MA | $3,894.36–$4,404.74 | 2 |
| MD | $3,747.71–$4,350.96 | 3 |
| ME | $3,412.73–$3,668.07 | 2 |
| MI | $3,393.16–$3,586.23 | 2 |
| MN | $3,800.99 | 1 |
| MO | $3,208.11–$3,531.96 | 3 |
| MS | $3,201.92 | 1 |
| MT | $3,704.47 | 1 |
| NC | $3,459.65 | 1 |
| ND | $3,697.95 | 1 |
| NE | $3,420.83 | 1 |
| NH | $3,850.51 | 1 |
| NJ | $4,040.24–$4,286.64 | 2 |
| NM | $3,408.33 | 1 |
| NV | $3,706.25 | 1 |
| NY | $3,521.47–$4,399.69 | 5 |
| OH | $3,391.82 | 1 |
| OK | $3,317.38 | 1 |
| OR | $3,686.84–$4,102.29 | 2 |
| PA | $3,409.10–$3,855.79 | 2 |
| PR | $3,743.87 | 1 |
| RI | $3,823.81 | 1 |
| SC | $3,429.63 | 1 |
| SD | $3,697.18 | 1 |
| TN | $3,372.25 | 1 |
| TX | $3,380.17–$3,911.94 | 8 |
| UT | $3,487.67 | 1 |
| VA | $3,640.14–$4,350.96 | 2 |
| VI | $3,743.87 | 1 |
| VT | $3,663.10 | 1 |
| WA | $3,893.67–$4,523.45 | 2 |
| WI | $3,545.88 | 1 |
| WV | $3,238.31 | 1 |
| WY | $3,701.63 | 1 |
How the 55874 rate is calculated
Each of 55874’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 · 55874
RVUs × geographic indexes × conversion factor
Work2.95
2.95 RVUs× 1.000 GPCI
Practice expense107.63
107.63 RVUs× 1.000 GPCI
Malpractice0.33
0.33 RVUs× 1.000 GPCI
Adjusted RVUs
110.9100
Conversion factor
$33.4009
Medicare rate
$3,704.49
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 55874
The CMS indicators that decide how 55874 is paid alongside other services.
CMS payment indicators · 55874
Prostate spacer
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is 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) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 1 | Permitted with supporting documentation. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
55874 without 51 · national office
$3,704.49
Prostate spacer
55874-51 · Second procedure: 50%
$1,852.25
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%).
55874 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 55876Prostate markers
- Use 55874 for biodegradable material placed around the prostate to create separation from the rectum; use 55876 for placement of radiation-localization markers.
- 55875Prostate brachytherapy
- 55875 covers transperineal placement of needles or catheters for prostate brachytherapy, rather than placement of a biodegradable spacer.
- 55873Prostate cryoablation
- 55873 reports prostate cryoablation. It describes treatment of prostate tissue, not spacer placement before radiation.
55874 billing questions
Can 55874 be reported with prostate fiducial marker placement?
Yes, 55876 may be reported for distinct fiducial marker placement performed in the same session. Document each service separately; the CMS multiple-procedure reduction may apply to procedures performed together.
Does 55874 include image guidance?
Yes. Image guidance performed for the spacer placement is included in 55874.
How many units should be reported if the physician places multiple deposits?
The code covers single or multiple placements during the procedure. Multiple deposits in that session do not by themselves support multiple units.
Should modifier 50 be appended for placement on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What are the assistant-at-surgery and co-surgeon payment rules?
An assistant at surgery is not paid for this service under the stated statutory restriction. Co-surgeons or a surgical team are payable only with supporting documentation.
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
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