No office rate
Both describe laparoscopic radical prostatectomy, but 55865 includes bilateral pelvic lymphadenectomy; 55866 is used when that dissection is not performed.
On this page
CMS RVU26D · Effective 2026-10-01
55865 in Modesto
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$1184.96
Base rate per service
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
Urologic surgery
About 55865: Laparoscopic radical prostatectomy with bilateral lymphadenectomy
Reports laparoscopic radical removal of the prostate with bilateral pelvic lymph node dissection, including nerve-sparing work when performed.
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.
CMS billing rules for 55865
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- The code is already priced as bilateral; modifier 50 does not increase payment.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU23.96 · 67%
- Practice expense (office) RVU8.64 · 24%
- Malpractice RVU3.06 · 9%
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.
55865 compared with similar codes
Office rates for Modesto, from the same CMS release.
No office rate
This is the open retropubic approach with bilateral pelvic lymphadenectomy. Use 55865 for the laparoscopic approach.
No office rate
This is an open radical prostatectomy with limited lymph node biopsy, not the laparoscopic procedure with bilateral pelvic lymphadenectomy.
The same code, a different location
How does Modesto compare?
55865 across payment areas
Same release and payment basis · bars start at $0
Modesto · This locality
Unavailable
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
No comparable rate is available in this setting.
Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Madera
California · 55865
Office
Unavailable
Facility
$1184.96
No comparable office rate is available.
Merced
California · 55865
Office
Unavailable
Facility
$1184.96
No comparable office rate is available.
Napa
California · 55865
Office
Unavailable
Facility
$1282.98
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 55865
Office
Unavailable
Facility
$1227.47
No comparable office rate is available.
Redding
California · 55865
Office
Unavailable
Facility
$1184.96
No comparable office rate is available.
Rest Of California
California · 55865
Office
Unavailable
Facility
$1184.96
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 55865
Office
Unavailable
Facility
$1218.16
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 55865
Office
Unavailable
Facility
$1219.50
No comparable office rate is available.
Salinas
California · 55865
Office
Unavailable
Facility
$1214.35
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 55865
Office
Unavailable
Facility
$1224.84
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 55865
Office
Unavailable
Facility
$1330.13
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 55865
Office
Unavailable
Facility
$1326.65
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 55865
Office
Unavailable
Facility
$1359.24
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 55865
Office
Unavailable
Facility
$1345.03
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 55865
Office
Unavailable
Facility
$1197.37
No comparable office rate is available.
Santa Cruz-Watsonville
California · 55865
Office
Unavailable
Facility
$1222.50
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 55865
Office
Unavailable
Facility
$1213.97
No comparable office rate is available.
Santa Rosa-Petaluma
California · 55865
Office
Unavailable
Facility
$1233.46
No comparable office rate is available.
Stockton
California · 55865
Office
Unavailable
Facility
$1184.96
No comparable office rate is available.
Vallejo
California · 55865
Office
Unavailable
Facility
$1277.97
No comparable office rate is available.
Visalia
California · 55865
Office
Unavailable
Facility
$1184.96
No comparable office rate is available.
Yuba City
California · 55865
Office
Unavailable
Facility
$1184.96
No comparable office rate is available.
Dc + Md/Va Suburbs
District of Columbia · 55865
Office
Unavailable
Facility
$1297.21
No comparable office rate is available.
Miami
Florida · 55865
Office
Unavailable
Facility
$1359.18
No comparable office rate is available.
Chicago
Illinois · 55865
Office
Unavailable
Facility
$1330.48
No comparable office rate is available.
Manhattan
New York · 55865
Office
Unavailable
Facility
$1348.94
No comparable office rate is available.
Alaska*
Alaska · 55865
Office
Unavailable
Facility
$1564.09
No comparable office rate is available.
Alabama
Alabama · 55865
Office
Unavailable
Facility
$1110.65
No comparable office rate is available.
Arkansas
Arkansas · 55865
Office
Unavailable
Facility
$1100.82
No comparable office rate is available.
Arizona
Arizona · 55865
Office
Unavailable
Facility
$1167.41
No comparable office rate is available.
Colorado
Colorado · 55865
Office
Unavailable
Facility
$1196.77
No comparable office rate is available.
Connecticut
Connecticut · 55865
Office
Unavailable
Facility
$1250.77
No comparable office rate is available.
Delaware
Delaware · 55865
Office
Unavailable
Facility
$1181.29
No comparable office rate is available.
Fort Lauderdale
Florida · 55865
Office
Unavailable
Facility
$1277.41
No comparable office rate is available.
Rest Of Florida
Florida · 55865
Office
Unavailable
Facility
$1229.79
No comparable office rate is available.
Atlanta
Georgia · 55865
Office
Unavailable
Facility
$1218.64
No comparable office rate is available.
Rest Of Georgia
Georgia · 55865
Office
Unavailable
Facility
$1179.53
No comparable office rate is available.
Hawaii, Guam
Hawaii · 55865
Office
Unavailable
Facility
$1187.58
No comparable office rate is available.
Iowa
Iowa · 55865
Office
Unavailable
Facility
$1104.92
No comparable office rate is available.
Idaho
Idaho · 55865
Office
Unavailable
Facility
$1114.13
No comparable office rate is available.
East St. Louis
Illinois · 55865
Office
Unavailable
Facility
$1271.63
No comparable office rate is available.
Rest Of Illinois
Illinois · 55865
Office
Unavailable
Facility
$1223.51
No comparable office rate is available.
Suburban Chicago
Illinois · 55865
Office
Unavailable
Facility
$1283.37
No comparable office rate is available.
Indiana
Indiana · 55865
Office
Unavailable
Facility
$1117.48
No comparable office rate is available.
Kansas
Kansas · 55865
Office
Unavailable
Facility
$1112.68
No comparable office rate is available.
Kentucky
Kentucky · 55865
Office
Unavailable
Facility
$1150.36
No comparable office rate is available.
New Orleans
Louisiana · 55865
Office
Unavailable
Facility
$1187.95
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 55865
Office
Unavailable
Facility
$1153.60
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 55865
Office
Unavailable
Facility
$1268.63
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 55865
Office
Unavailable
Facility
$1198.43
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 55865
Office
Unavailable
Facility
$1249.17
No comparable office rate is available.
Rest Of Maryland
Maryland · 55865
Office
Unavailable
Facility
$1194.16
No comparable office rate is available.
Rest Of Maine
Maine · 55865
Office
Unavailable
Facility
$1129.36
No comparable office rate is available.
Southern Maine
Maine · 55865
Office
Unavailable
Facility
$1150.76
No comparable office rate is available.
Detroit
Michigan · 55865
Office
Unavailable
Facility
$1251.09
No comparable office rate is available.
Rest Of Michigan
Michigan · 55865
Office
Unavailable
Facility
$1179.15
No comparable office rate is available.
Minnesota
Minnesota · 55865
Office
Unavailable
Facility
$1127.49
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 55865
Office
Unavailable
Facility
$1171.12
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 55865
Office
Unavailable
Facility
$1177.43
No comparable office rate is available.
Rest Of Missouri
Missouri · 55865
Office
Unavailable
Facility
$1148.59
No comparable office rate is available.
Mississippi
Mississippi · 55865
Office
Unavailable
Facility
$1124.29
No comparable office rate is available.
Montana**
Montana · 55865
Office
Unavailable
Facility
$1190.87
No comparable office rate is available.
North Carolina
North Carolina · 55865
Office
Unavailable
Facility
$1134.84
No comparable office rate is available.
North Dakota**
North Dakota · 55865
Office
Unavailable
Facility
$1130.37
No comparable office rate is available.
Nebraska
Nebraska · 55865
Office
Unavailable
Facility
$1105.28
No comparable office rate is available.
New Hampshire
New Hampshire · 55865
Office
Unavailable
Facility
$1190.13
No comparable office rate is available.
Northern Nj
New Jersey · 55865
Office
Unavailable
Facility
$1294.62
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 55865
Office
Unavailable
Facility
$1259.55
No comparable office rate is available.
New Mexico
New Mexico · 55865
Office
Unavailable
Facility
$1187.67
No comparable office rate is available.
Nevada**
Nevada · 55865
Office
Unavailable
Facility
$1174.30
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 55865
Office
Unavailable
Facility
$1384.43
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 55865
Office
Unavailable
Facility
$1275.97
No comparable office rate is available.
Queens
New York · 55865
Office
Unavailable
Facility
$1339.99
No comparable office rate is available.
Rest Of New York
New York · 55865
Office
Unavailable
Facility
$1146.29
No comparable office rate is available.
Ohio
Ohio · 55865
Office
Unavailable
Facility
$1166.79
No comparable office rate is available.
Oklahoma
Oklahoma · 55865
Office
Unavailable
Facility
$1137.41
No comparable office rate is available.
Portland
Oregon · 55865
Office
Unavailable
Facility
$1209.75
No comparable office rate is available.
Rest Of Oregon
Oregon · 55865
Office
Unavailable
Facility
$1159.57
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 55865
Office
Unavailable
Facility
$1237.04
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 55865
Office
Unavailable
Facility
$1161.79
No comparable office rate is available.
Puerto Rico
Puerto Rico · 55865
Office
Unavailable
Facility
$1192.72
No comparable office rate is available.
Rhode Island
Rhode Island · 55865
Office
Unavailable
Facility
$1204.77
No comparable office rate is available.
South Carolina
South Carolina · 55865
Office
Unavailable
Facility
$1153.81
No comparable office rate is available.
South Dakota**
South Dakota · 55865
Office
Unavailable
Facility
$1123.21
No comparable office rate is available.
Tennessee
Tennessee · 55865
Office
Unavailable
Facility
$1117.49
No comparable office rate is available.
Austin
Texas · 55865
Office
Unavailable
Facility
$1197.76
No comparable office rate is available.
Beaumont
Texas · 55865
Office
Unavailable
Facility
$1157.85
No comparable office rate is available.
Brazoria
Texas · 55865
Office
Unavailable
Facility
$1172.40
No comparable office rate is available.
Dallas
Texas · 55865
Office
Unavailable
Facility
$1182.61
No comparable office rate is available.
Fort Worth
Texas · 55865
Office
Unavailable
Facility
$1181.05
No comparable office rate is available.
Galveston
Texas · 55865
Office
Unavailable
Facility
$1177.88
No comparable office rate is available.
Houston
Texas · 55865
Office
Unavailable
Facility
$1233.89
No comparable office rate is available.
Rest Of Texas
Texas · 55865
Office
Unavailable
Facility
$1166.44
No comparable office rate is available.
Utah
Utah · 55865
Office
Unavailable
Facility
$1163.34
No comparable office rate is available.
Virginia
Virginia · 55865
Office
Unavailable
Facility
$1156.12
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 55865
Office
Unavailable
Facility
$1192.72
No comparable office rate is available.
Vermont
Vermont · 55865
Office
Unavailable
Facility
$1137.70
No comparable office rate is available.
Rest Of Washington
Washington · 55865
Office
Unavailable
Facility
$1192.35
No comparable office rate is available.
Seattle (King Cnty)
Washington · 55865
Office
Unavailable
Facility
$1277.90
No comparable office rate is available.
Wisconsin
Wisconsin · 55865
Office
Unavailable
Facility
$1108.23
No comparable office rate is available.
West Virginia
West Virginia · 55865
Office
Unavailable
Facility
$1197.32
No comparable office rate is available.
Wyoming**
Wyoming · 55865
Office
Unavailable
Facility
$1164.50
No comparable office rate is available.
See how rates vary across the country
55865 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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 all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Where does this rate apply?
Modesto is a Medicare payment area. Our Census mapping connects it to 33 cities and communities in California, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 55865 in Modesto. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$1303.46
$1184.96 × 110% = $1303.46
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 55865 in Modesto.
PPRRVU2026_Oct_nonQPP.csv
6,385
- Code
- 55865
- Physician work
- 23.96
- Practice expense
- 8.64
- Malpractice
- 3.06
GPCI2026.csv
16
- Locality
- Modesto
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 23.96 | × 1.017 | 24.3673 |
| Practice expense | 8.64 | × 1.096 | 9.4694 |
| Malpractice | 3.06 | × 0.536 | 1.6402 |
| Total RVUs | 35.4769 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Modesto$1184.96
Open 55865 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 23.96 | 1.017 |
| Practice expense | 8.64 | 1.096 |
| Malpractice | 3.06 | 0.536 |
(23.96 × 1.017 + 8.64 × 1.096 + 3.06 × 0.536) × $33.4009 = $1184.96
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
55865 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $1184.96 | RVU26D |
| 2026-07-01 | Not available in this setting | $1184.96 | RVU26C |
| 2026-04-01 | Not available in this setting | $1184.96 | RVU26B |
| 2026-01-01 | Not available in this setting | $1184.96 | RVU26A |
| 2025-10-01 | Not available in this setting | $1297.55 | RVU25D |
| 2025-07-01 | Not available in this setting | $1297.55 | RVU25C |
| 2025-04-01 | Not available in this setting | $1297.55 | RVU25B |
| 2025-01-01 | Not available in this setting | $1297.55 | RVU25A |
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
6,38255845,,Extensive prostate surgery,A,,24.55,8.49,NA,8.49,,3.17,36.21,36.21,0,090,0.10,0.80,0.10,2,2,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,38355860,,Surgical exposure prostate,A,,15.44,6.11,NA,6.11,,1.98,23.53,23.53,0,090,0.10,0.80,0.10,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,38455862,,Extensive prostate surgery,A,,19.54,7.33,NA,7.33,,2.51,29.38,29.38,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,38555865,,Extensive prostate surgery,A,,23.96,8.64,NA,8.64,,3.06,35.66,35.66,0,090,0.10,0.80,0.10,2,2,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,38655866,,Laps surg prst8ect rpbic rad,A,,21.90,7.66,NA,7.66,,2.83,32.39,32.39,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,38755867,,Laps surg prst8ect smpl stot,A,,19.04,6.82,NA,6.82,,2.46,28.32,28.32,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,38855868,,Lap srg prst8ct lymph nod bx,A,,22.46,7.79,NA,7.79,,2.91,33.16,33.16,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1301182,CA,18,LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY),1.041,1.183,0.664
1401112,CA,58,MADERA,1.017,1.096,0.536
1501112,CA,59,MERCED,1.017,1.096,0.536
1601112,CA,60,MODESTO,1.017,1.096,0.536
1701112,CA,51,NAPA,1.063,1.318,0.508
1801182,CA,17,OXNARD-THOUSAND OAKS-VENTURA,1.028,1.182,0.623
1901112,CA,61,REDDING,1.017,1.096,0.536