No office rate
Choose 55869 when the laparoscopic radical prostatectomy includes bilateral pelvic lymphadenectomy. Code 55866 describes the laparoscopic radical prostatectomy without that specified lymphadenectomy.
On this page
CMS RVU26D · Effective 2026-10-01
55869 Prostatectomy Medicare reimbursement rates in Idaho
Reports laparoscopic radical prostate removal with bilateral pelvic lymphadenectomy, typically performed by a urologist for prostate cancer. Compare 55869 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 55869 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
$1242.63
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.
Urologic surgery
About 55869: Laparoscopic radical prostatectomy with bilateral lymphadenectomy
Reports laparoscopic radical prostate removal with bilateral pelvic lymphadenectomy, typically performed by a urologist for prostate cancer.
A urologist performs this laparoscopic operation to remove the prostate and dissect lymph nodes on both sides of the pelvis. It is used in the surgical treatment of prostate cancer and is generally performed in an operating room. The operative report should establish that the prostatectomy was radical and that bilateral pelvic lymphadenectomy was performed; node sampling by biopsy alone is a different service.
Report this code for the combined laparoscopic procedure, rather than for a prostatectomy without the specified bilateral lymphadenectomy. CMS assigns a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 55869
- 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 RVU27.41 · 69%
- Practice expense (office) RVU8.82 · 22%
- Malpractice RVU3.55 · 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.
55869 compared with similar codes
Office rates for Idaho, from the same CMS release.
No office rate
55868 identifies laparoscopic prostatectomy with pelvic lymph node biopsy. This code identifies the operation with bilateral pelvic lymphadenectomy.
No office rate
Both describe radical prostatectomy with bilateral pelvic lymphadenectomy, but 55845 is the open operation and this code is laparoscopic.
No office rate
55867 describes laparoscopic simple subtotal prostatectomy. This code is for a radical prostatectomy with bilateral pelvic lymphadenectomy.
Compare 55869 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
$1242.63
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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 55869 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
6,389
- Code
- 55869
- Physician work
- 27.41
- Practice expense
- 8.82
- Malpractice
- 3.55
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 27.41 | × 1.000 | 27.4100 |
| Practice expense | 8.82 | × 0.920 | 8.1144 |
| Malpractice | 3.55 | × 0.473 | 1.6791 |
| Total RVUs | 37.2035 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Idaho$1242.63
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 27.41 | 1 |
| Practice expense | 8.82 | 0.92 |
| Malpractice | 3.55 | 0.473 |
(27.41 × 1 + 8.82 × 0.92 + 3.55 × 0.473) × $33.4009 = $1242.63
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.
55869 billing questions
How does this differ from 55866?
This code describes laparoscopic radical prostatectomy with bilateral pelvic lymphadenectomy. Code 55866 describes the laparoscopic radical prostatectomy without that bilateral lymphadenectomy specified.
Is bilateral lymphadenectomy included in this service?
Yes. Bilateral pelvic lymphadenectomy is part of the combined service represented by this code; the operative report should document the dissection.
Should modifier 50 be appended?
No. CMS identifies bilateral adjustment as inappropriate for this code because the descriptor or anatomy already accounts for the bilateral service.
What global period applies?
The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
How are other same-session procedures paid?
Under the standard multiple-procedure rule, the highest-valued procedure is paid in full and other procedures performed in the same session are subject to a reduction.
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.
6,38655866,,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
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
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