No office rate
Choose 55862 when the surgical exposure includes insertion of radioactive seeds. Code 55860 covers exposure for localized cancer treatment with or without biopsy, without that seed-insertion distinction.
On this page
CMS RVU26D · Effective 2026-10-01
55860 Prostate exposure Medicare reimbursement rates in Colorado
Reports surgical access to the prostate for treatment of localized prostate cancer, whether or not a biopsy is performed during the exposure. Compare 55860 office and facility rates across CMS payment localities in Colorado.
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 55860 in Colorado?
Colorado has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$790.69
1 of 1 localities have a supported rate.
Payment area: Colorado
One mapped payment locality.
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.
Urologic surgery
About 55860: Surgical prostate exposure for cancer treatment
Reports surgical access to the prostate for treatment of localized prostate cancer, whether or not a biopsy is performed during the exposure.
A urologist surgically exposes the prostate to enable treatment of localized prostate cancer. The approach may vary, and a biopsy may be performed during the same service. This code describes the exposure for treatment, rather than removal of the prostate or a percutaneous prostate procedure. It is generally performed in an operating room, with the operative report identifying the approach, the cancer-treatment purpose, and any biopsy performed.
Report the code when the documented service is surgical exposure for localized cancer treatment; the biopsy, if performed as part of that exposure, is included. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures are performed in the same session, Medicare pays the highest-valued procedure in full and reduces the others to 50%. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 55860
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU15.44 · 66%
- Practice expense (office) RVU6.11 · 26%
- Malpractice RVU1.98 · 8%
17
Medicare services in 2024 · #6013 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.
55860 compared with similar codes
Office rates for Colorado, from the same CMS release.
No office rate
55840 reports retropubic radical prostatectomy, which removes the prostate. 55860 is for surgical exposure to enable treatment and does not describe prostate removal.
No office rate
55875 describes transperineal placement of needles or catheters into the prostate. Use 55860 when the documented service is surgical exposure for localized cancer treatment.
Compare 55860 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.
1 of 1 payment localities
Colorado →
Office / nonfacility
Unavailable
Facility
$790.69
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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 55860 in Colorado.
PPRRVU2026_Oct_nonQPP.csv
6,383
- Code
- 55860
- Physician work
- 15.44
- Practice expense
- 6.11
- Malpractice
- 1.98
GPCI2026.csv
37
- Locality
- Colorado
- Physician work
- 1.012
- Practice expense
- 1.064
- Malpractice
- 0.781
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 15.44 | × 1.012 | 15.6253 |
| Practice expense | 6.11 | × 1.064 | 6.5010 |
| Malpractice | 1.98 | × 0.781 | 1.5464 |
| Total RVUs | 23.6727 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Colorado$790.69
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 15.44 | 1.012 |
| Practice expense | 6.11 | 1.064 |
| Malpractice | 1.98 | 0.781 |
(15.44 × 1.012 + 6.11 × 1.064 + 1.98 × 0.781) × $33.4009 = $790.69
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.
55860 billing questions
How is this code different from 55862?
Use 55860 for surgical exposure for localized prostate cancer treatment, with or without biopsy. Code 55862 describes exposure that includes insertion of radioactive seeds.
Can a biopsy performed during the exposure be billed separately?
The code includes the exposure whether or not a biopsy is performed. A biopsy that is part of that service is not separately reported as additional work.
Should modifier 50 be used for bilateral work?
No. Modifier 50 is inappropriate for this code; the surgical exposure is reported as one service.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeons are payable only when supporting documentation is provided; 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 through 90 days after surgery.
How does Medicare handle another procedure performed in the same session?
Under the standard multiple procedure reduction, Medicare pays the highest-valued procedure in full and reduces the other procedures to 50%.
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.
6,38055840,,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
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
3401112,CA,69,VISALIA,1.017,1.096,0.536
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899