No office rate
Choose 55842 when the open retropubic radical prostatectomy includes limited bilateral pelvic lymphadenectomy. Choose 55840 when that nodal dissection is not performed.
On this page
CMS RVU26D · Effective 2026-10-01
55842 Radical prostatectomy Medicare reimbursement rates in Idaho
Open retropubic radical prostatectomy with limited bilateral pelvic lymphadenectomy is reported when the prostate operation includes this defined nodal dissection. Compare 55842 office and facility rates across CMS payment localities in Idaho.
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 55842 in Idaho?
Idaho 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
$975.00
1 of 1 localities have a supported rate.
Payment area: Idaho
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 surgery
About 55842: Open Retropubic Radical Prostatectomy with Limited Node Dissection
Open retropubic radical prostatectomy with limited bilateral pelvic lymphadenectomy is reported when the prostate operation includes this defined nodal dissection.
An urologist reports 55842 for an open retropubic radical prostatectomy that removes the prostate together with limited bilateral pelvic lymph-node dissection. It is used most often for prostate cancer when the operative plan includes nodal staging. The hospital operating room is the typical setting; this code distinguishes the retropubic approach and limited node dissection from perineal, laparoscopic, or more extensive operations.
Choose the code from the operative report’s approach and extent: open retropubic radical removal plus limited bilateral pelvic node work. Documentation should support the radical prostatectomy and the extent and laterality of the lymphadenectomy. This major surgery has a 90-day global period that includes the day-before preoperative visit and related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted. Modifier 50 is inappropriate.
CMS billing rules for 55842
- 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 RVU20.83 · 67%
- Practice expense (office) RVU7.71 · 25%
- Malpractice RVU2.68 · 9%
49
Medicare services in 2024 · #5366 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.
55842 compared with similar codes
Office rates for Idaho, from the same CMS release.
No office rate
Both are open retropubic radical procedures with bilateral pelvic lymphadenectomy. 55845 reflects the more extensive dissection involving external iliac, hypogastric, and obturator nodes.
No office rate
55812 uses the perineal approach for radical prostatectomy with bilateral pelvic lymphadenectomy; 55842 is the retropubic approach with limited nodal dissection.
No office rate
55866 represents laparoscopic radical retropubic prostatectomy, including robotic-assisted surgery. Use 55842 for the open retropubic operation with limited bilateral pelvic lymphadenectomy.
Compare 55842 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
Idaho →
Office / nonfacility
Unavailable
Facility
$975.00
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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 55842 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
6,381
- Code
- 55842
- Physician work
- 20.83
- Practice expense
- 7.71
- Malpractice
- 2.68
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 20.83 | × 1.000 | 20.8300 |
| Practice expense | 7.71 | × 0.920 | 7.0932 |
| Malpractice | 2.68 | × 0.473 | 1.2676 |
| Total RVUs | 29.1908 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Idaho$975.00
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 20.83 | 1 |
| Practice expense | 7.71 | 0.92 |
| Malpractice | 2.68 | 0.473 |
(20.83 × 1 + 7.71 × 0.92 + 2.68 × 0.473) × $33.4009 = $975.00
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.
55842 billing questions
How is 55842 different from 55840?
Both describe open retropubic radical prostatectomy, but 55842 includes limited bilateral pelvic lymphadenectomy. Use 55840 when that nodal dissection is not part of the operation.
When should 55845 be used instead?
55845 is for the retropubic radical operation with the more extensive bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes. The operative report should support that greater extent rather than a limited dissection.
Can the pelvic lymphadenectomy be billed separately?
The limited bilateral pelvic lymphadenectomy is included in 55842. Do not separately report the same nodal-dissection work.
Can modifier 50 be appended?
No. CMS lists bilateral adjustment as inapplicable for this code; the bilateral nodal work is represented in the code.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.
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.
6,37855821,,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
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
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772