No office rate
Both are subtotal procedures; 55831 uses a retropubic route, while 55821 uses a suprapubic route. Follow the documented operative approach.
On this page
CMS RVU26D · Effective 2026-10-01
55831 Prostatectomy Medicare reimbursement rates in California
Open retropubic subtotal prostatectomy removes obstructing prostate tissue for selected patients with benign enlargement when an open simple-prostatectomy approach is performed. Compare 55831 office and facility rates across CMS payment localities in California.
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.
What does Medicare pay for 55831 in California?
California has 29 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 29 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$771.75–$888.22
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $116.47 per service.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 55831 pays more and less in California
Urologic surgery
About 55831: Retropubic subtotal prostatectomy
Open retropubic subtotal prostatectomy removes obstructing prostate tissue for selected patients with benign enlargement when an open simple-prostatectomy approach is performed.
This open operation removes the obstructing portion of an enlarged prostate through a retropubic approach, leaving the outer prostate capsule rather than removing the gland as a cancer operation. Urologists typically perform it in a hospital operating room for patients with benign prostatic enlargement who need surgical treatment. The operative approach distinguishes this service from subtotal procedures using a perineal or suprapubic route and from radical prostatectomy.
Report 55831 when the operative record supports subtotal removal by the retropubic route. Documentation should identify the indication, surgical approach, and extent of tissue removed. The code includes related services named in its descriptor, such as control of postoperative bleeding, vasectomy, meatotomy, urethral calibration or dilation, and internal urethrotomy when performed as part of the operation. It has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. In a same-session multiple-procedure claim, 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.
CMS billing rules for 55831
- 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
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- 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 RVU15.21 · 66%
- Practice expense (office) RVU5.99 · 26%
- Malpractice RVU2.00 · 9%
182
Medicare services in 2024 · #4411 by national volume
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.
55831 compared with similar codes
Office rates for California, from the same CMS release.
No office rate
55801 is the perineal subtotal procedure. Use 55831 for subtotal removal performed through a retropubic approach.
No office rate
55840 describes radical retropubic prostatectomy, not subtotal removal. Select based on whether the operative report documents radical gland removal or a simple/subtotal procedure.
No office rate
Both involve simple/subtotal prostate removal, but 55867 is laparoscopic and 55831 is the open retropubic procedure.
Compare 55831 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield | Office Unavailable | Facility $777.64 |
| Chico | Office Unavailable | Facility $771.75 |
| El Centro | Office Unavailable | Facility $772.08 |
| Fresno | Office Unavailable | Facility $771.75 |
| Hanford-Corcoran | Office Unavailable | Facility $771.75 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $809.90 |
| Madera | Office Unavailable | Facility $771.75 |
| Merced | Office Unavailable | Facility $771.75 |
| Modesto | Office Unavailable | Facility $771.75 |
| Napa | Office Unavailable | Facility $837.66 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $800.35 |
| Redding | Office Unavailable | Facility $771.75 |
| Rest Of California | Office Unavailable | Facility $771.75 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $793.43 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $794.81 |
| Salinas | Office Unavailable | Facility $791.47 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $798.76 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $869.05 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $866.78 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $888.22 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $878.93 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $780.35 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $797.59 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $791.34 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $804.76 |
| Stockton | Office Unavailable | Facility $771.75 |
| Vallejo | Office Unavailable | Facility $834.39 |
| Visalia | Office Unavailable | Facility $771.75 |
| Yuba City | Office Unavailable | Facility $771.75 |
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55831 billing questions
How does 55831 differ from 55821?
Both describe subtotal prostate removal, but 55831 is the retropubic approach and 55821 is the suprapubic approach. The operative report must support the route performed.
When would 55801 be reported instead?
55801 describes subtotal prostate removal through a perineal approach. Choose 55831 when the surgeon uses the retropubic route.
Is 55831 a radical prostatectomy?
No. It represents subtotal removal, typically for benign enlargement, rather than radical removal of the prostate for cancer. Radical retropubic surgery is represented by codes such as 55840.
Can associated procedures be billed separately?
Services identified as included in the descriptor—such as control of postoperative bleeding, vasectomy, meatotomy, urethral calibration or dilation, and internal urethrotomy—are part of the operation when performed as related services.
What are the assistant and co-surgeon rules?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
Does modifier 50 apply, and what is the global period?
Modifier 50 is inappropriate for this procedure. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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.
6,37655812,,Extensive prostate surgery,A,,29.14,9.94,NA,9.94,,3.75,42.83,42.83,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,37755815,,Extensive prostate surgery,A,,32.13,10.56,NA,10.56,,4.13,46.82,46.82,0,090,0.10,0.80,0.10,2,2,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,37855821,,Removal of prostate,A,,14.80,5.90,NA,5.90,,1.91,22.61,22.61,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,37955831,,Removal of prostate,A,,15.21,5.99,NA,5.99,,2.00,23.20,23.20,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,38055840,,Extensive prostate surgery,A,,20.83,7.74,NA,7.74,,2.72,31.29,31.29,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,38155842,,Extensive prostate surgery,A,,20.83,7.71,NA,7.71,,2.68,31.22,31.22,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,38255845,,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