$149.89
Use 55874 for biodegradable material placed around the prostate to create separation from the rectum; use 55876 for placement of radiation-localization markers.
On this page
CMS RVU26D · Effective 2026-10-01
55874 Prostate spacer Medicare reimbursement rates in Delaware
Reports transperineal placement of biodegradable material around the prostate, commonly before radiation therapy to increase separation between the prostate and rectum. Compare 55874 office and facility rates across CMS payment localities in Delaware.
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 55874 in Delaware?
Delaware 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
$3660.73
1 of 1 localities have a supported rate.
Payment area: Delaware
One mapped payment locality.
Facility setting
$141.60
1 of 1 localities have a supported rate.
Payment area: Delaware
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.
Urology procedure
About 55874: Transperineal periprostatic spacer placement
Reports transperineal placement of biodegradable material around the prostate, commonly before radiation therapy to increase separation between the prostate and rectum.
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.
CMS billing rules for 55874
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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 paid only with supporting documentation.
Where the value comes from
- Work RVU2.95 · 3%
- Practice expense (office) RVU107.63 · 97%
- Malpractice RVU0.33 · 0%
25.7K
Medicare services in 2024 · #1037 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.
55874 compared with similar codes
Office rates for Delaware, from the same CMS release.
No office rate
55875 covers transperineal placement of needles or catheters for prostate brachytherapy, rather than placement of a biodegradable spacer.
$5,625.72
55873 reports prostate cryoablation. It describes treatment of prostate tissue, not spacer placement before radiation.
Compare 55874 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
Delaware →
Office / nonfacility
$3660.73
Facility
$141.60
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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 55874 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
6,392
- Code
- 55874
- Physician work
- 2.95
- Practice expense
- 107.63
- Malpractice
- 0.33
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.95 | × 1.005 | 2.9647 |
| Practice expense | 107.63 | × 0.988 | 106.3384 |
| Malpractice | 0.33 | × 0.899 | 0.2967 |
| Total RVUs | 109.5999 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Delaware$3660.73
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.95 | 1.005 |
| Practice expense | 107.63 | 0.988 |
| Malpractice | 0.33 | 0.899 |
(2.95 × 1.005 + 107.63 × 0.988 + 0.33 × 0.899) × $33.4009 = $3660.73
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.95 | 1.005 |
| Practice expense | 0.99 | 0.988 |
| Malpractice | 0.33 | 0.899 |
(2.95 × 1.005 + 0.99 × 0.988 + 0.33 × 0.899) × $33.4009 = $141.60
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.
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 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.
6,38955869,,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
6,39255874,,Tprnl plmt biodegrdabl matrl,A,,2.95,107.63,,0.99,,0.33,110.91,4.27,0,000,0.00,0.00,0.00,2,0,1,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
6,39355875,,Transperi needle place pros,A,,13.12,6.05,NA,6.05,,1.42,20.59,20.59,0,090,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,39455876,,Place rt device/marker pros,A,,1.69,2.65,,0.84,,0.19,4.53,2.72,0,000,0.00,0.00,0.00,2,0,1,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
6,39555877,,Abltj ire prst8 1+ tum perq,A,,13.50,4.99,NA,4.99,,1.61,20.10,20.10,0,090,0.08,0.83,0.09,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503