No office rate
Choose 55868 when lymph node biopsy accompanies the laparoscopic radical prostatectomy; 55866 is for the laparoscopic radical prostatectomy without that biopsy.
On this page
CMS RVU26D · Effective 2026-10-01
55868 Prostatectomy Medicare reimbursement rates in California
Reports laparoscopic radical prostate removal with lymph node biopsy, including robotic assistance when performed, for a documented operative approach and nodal sampling. Compare 55868 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 55868 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
$1100.21–$1260.00
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $159.79 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 55868 pays more and less in California
Urologic surgery
About 55868: Laparoscopic radical prostatectomy with node biopsy
Reports laparoscopic radical prostate removal with lymph node biopsy, including robotic assistance when performed, for a documented operative approach and nodal sampling.
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.
CMS billing rules for 55868
- 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 RVU22.46 · 68%
- Practice expense (office) RVU7.79 · 23%
- Malpractice RVU2.91 · 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.
55868 compared with similar codes
Office rates for California, from the same CMS release.
No office rate
55869 represents laparoscopic radical prostatectomy with bilateral pelvic lymphadenectomy. 55868 represents lymph node biopsy rather than that bilateral dissection.
No office rate
Both involve radical prostatectomy and bilateral pelvic nodal surgery, but 55845 is the open approach; 55868 is laparoscopic and describes lymph node biopsy.
Compare 55868 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 $1108.80 |
| Chico | Office Unavailable | Facility $1100.21 |
| El Centro | Office Unavailable | Facility $1100.69 |
| Fresno | Office Unavailable | Facility $1100.21 |
| Hanford-Corcoran | Office Unavailable | Facility $1100.21 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $1153.29 |
| Madera | Office Unavailable | Facility $1100.21 |
| Merced | Office Unavailable | Facility $1100.21 |
| Modesto | Office Unavailable | Facility $1100.21 |
| Napa | Office Unavailable | Facility $1189.76 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $1139.29 |
| Redding | Office Unavailable | Facility $1100.21 |
| Rest Of California | Office Unavailable | Facility $1100.21 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $1131.77 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $1131.89 |
| Salinas | Office Unavailable | Facility $1127.10 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $1136.56 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $1232.94 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $1229.63 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $1260.00 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $1246.49 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $1111.39 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $1134.17 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $1126.67 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $1144.30 |
| Stockton | Office Unavailable | Facility $1100.21 |
| Vallejo | Office Unavailable | Facility $1184.99 |
| Visalia | Office Unavailable | Facility $1100.21 |
| Yuba City | Office Unavailable | Facility $1100.21 |
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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 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.
6,38555865,,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
6,38955869,,Lap srg prst8ct bi pl lmphad,A,,27.41,8.82,NA,8.82,,3.55,39.78,39.78,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,39055870,,Electroejaculation,A,,2.52,2.70,,0.97,,0.33,5.55,3.82,0,000,0.00,0.00,0.00,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,39155873,,Cryoablate prostate,A,,13.26,155.45,,5.66,,1.69,170.40,20.61,0,090,0.08,0.83,0.09,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00