No office rate
55812 describes retropubic radical prostatectomy without the bilateral pelvic lymphadenectomy included in 55862. Choose based on the operation actually documented.
On this page
CMS RVU26D · Effective 2026-10-01
55862 Radical prostatectomy Medicare reimbursement rates in Indiana
Reports retropubic removal of the prostate for malignancy with nerve sparing and bilateral pelvic lymph node dissection during the same operation. Compare 55862 office and facility rates across CMS payment localities in Indiana.
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 55862 in Indiana?
Indiana 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
$920.35
1 of 1 localities have a supported rate.
Payment area: Indiana
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 55862: Retropubic radical prostatectomy with pelvic lymphadenectomy
Reports retropubic removal of the prostate for malignancy with nerve sparing and bilateral pelvic lymph node dissection during the same operation.
A urologist performs this open retropubic operation to remove the prostate, preserve the neurovascular bundles when feasible, and dissect pelvic lymph nodes on both sides. It is used in the surgical treatment of prostate cancer. The operative record should identify the approach, prostate removal, nerve-sparing work, and bilateral lymph node dissection performed.
Report one unit for the completed operation. The documentation should support the full service rather than prostate removal alone or a separate node procedure. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during the 90 days after surgery. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted. Modifier 50 is inappropriate for this code.
CMS billing rules for 55862
- 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 RVU19.54 · 67%
- Practice expense (office) RVU7.33 · 25%
- Malpractice RVU2.51 · 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.
55862 compared with similar codes
Office rates for Indiana, from the same CMS release.
No office rate
Both describe retropubic radical prostatectomy with bilateral pelvic lymphadenectomy. Distinguish 55862 by its nerve-sparing service.
No office rate
55845 represents a related retropubic operation with a more extensive pelvic node dissection. Use the code matching the documented extent and components.
No office rate
55866 describes a laparoscopic radical prostatectomy; 55862 is the open retropubic service. Select by operative approach.
Compare 55862 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
Indiana →
Office / nonfacility
Unavailable
Facility
$920.35
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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 55862 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
6,384
- Code
- 55862
- Physician work
- 19.54
- Practice expense
- 7.33
- Malpractice
- 2.51
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 19.54 | × 1.000 | 19.5400 |
| Practice expense | 7.33 | × 0.927 | 6.7949 |
| Malpractice | 2.51 | × 0.486 | 1.2199 |
| Total RVUs | 27.5548 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Indiana$920.35
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 19.54 | 1 |
| Practice expense | 7.33 | 0.927 |
| Malpractice | 2.51 | 0.486 |
(19.54 × 1 + 7.33 × 0.927 + 2.51 × 0.486) × $33.4009 = $920.35
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.
55862 billing questions
How does this differ from a radical prostatectomy without lymphadenectomy?
Report 55862 when the retropubic radical prostatectomy includes bilateral pelvic lymph node dissection and the nerve-sparing work represented by this code. A prostatectomy without the documented node dissection is not this service.
Can the pelvic lymph node dissection be billed separately?
The bilateral node dissection is part of this combined prostate operation. Do not report it again as a separate service for the same operative work.
Should modifier 50 be appended for bilateral node dissection?
No. CMS identifies bilateral adjustment as inappropriate for this code; bilateral dissection is included in the service.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
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 procedures in the same session paid?
Under the standard multiple-procedure rule, the highest-valued procedure is paid in full and other procedures are subject to a 50% 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.
6,38155842,,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
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
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915