No office rate
Both describe radical perineal prostatectomy, but 55815 includes bilateral pelvic lymphadenectomy. Select 55810 when that nodal dissection is not performed.
On this page
CMS RVU26D · Effective 2026-10-01
55815 Radical prostatectomy Medicare reimbursement rates in Illinois
Reports radical prostate removal through a perineal approach with bilateral pelvic lymphadenectomy, including the specified pelvic nodal regions. Compare 55815 office and facility rates across CMS payment localities in Illinois.
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 55815 in Illinois?
Illinois has 4 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 4 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1610.81–$1751.75
4 of 4 localities have a supported rate.
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 55815 pays more and less in Illinois
Urologic surgery
About 55815: Perineal radical prostatectomy with bilateral lymphadenectomy
Reports radical prostate removal through a perineal approach with bilateral pelvic lymphadenectomy, including the specified pelvic nodal regions.
This code describes radical removal of the prostate through an incision in the perineum, combined with lymph node dissection on both sides of the pelvis. The nodal work includes the external iliac, hypogastric, and obturator regions. A urologist typically performs the operation in a surgical setting for prostate cancer when this perineal approach and bilateral dissection are selected.
Choose this code when the operative report supports both the radical perineal prostatectomy and bilateral pelvic lymphadenectomy; perineal prostatectomy with only node biopsies is a different level of service. The code is priced as bilateral, so modifier 50 does not increase payment. It has a 90-day global period, including the day-before preoperative visit and 90 days of 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. Team surgery is not permitted.
CMS billing rules for 55815
- 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
- The code is already priced as bilateral; modifier 50 does not increase payment.
- 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 RVU32.13 · 69%
- Practice expense (office) RVU10.56 · 23%
- Malpractice RVU4.13 · 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.
55815 compared with similar codes
Office rates for Illinois, from the same CMS release.
No office rate
55812 represents perineal radical prostatectomy with lymph node biopsies. Use 55815 when the documented nodal work is bilateral pelvic lymphadenectomy.
No office rate
Both include radical prostatectomy and bilateral pelvic lymphadenectomy; 55845 uses a retropubic approach, while 55815 uses a perineal approach.
No office rate
55866 describes a laparoscopic retropubic radical prostatectomy. Distinguish it from 55815 by the documented operative approach and included service.
Compare 55815 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.
4 of 4 payment localities
Chicago →
Office / nonfacility
Unavailable
Facility
$1751.75
East St. Louis →
Office / nonfacility
Unavailable
Facility
$1675.49
Rest Of Illinois →
Office / nonfacility
Unavailable
Facility
$1610.81
Suburban Chicago →
Office / nonfacility
Unavailable
Facility
$1687.36
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55815 billing questions
How does this differ from 55812?
55815 represents bilateral pelvic lymphadenectomy with radical perineal prostatectomy. 55812 is the perineal radical procedure with lymph node biopsies, rather than the bilateral dissection represented by 55815.
Can the pelvic lymphadenectomy be billed separately?
The bilateral pelvic lymphadenectomy is included in 55815. The operative report should support the bilateral dissection and the nodal regions addressed.
Should modifier 50 be appended?
The code is already priced as bilateral, and modifier 50 does not increase payment.
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.
What happens when another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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.
6,37455801,,Removal of prostate,A,,19.31,7.65,NA,7.65,,2.48,29.44,29.44,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,37555810,,Extensive prostate surgery,A,,23.68,8.16,NA,8.16,,3.04,34.88,34.88,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,37655812,,Extensive prostate surgery,A,,29.14,9.94,NA,9.94,,3.75,42.83,42.83,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,37755815,,Extensive prostate surgery,A,,32.13,10.56,NA,10.56,,4.13,46.82,46.82,0,090,0.10,0.80,0.10,2,2,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,37855821,,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