Billing code 55874: Prostate spacerMedicare rate & RVUs in Iowa
Reports transperineal placement of biodegradable material around the prostate, commonly before radiation therapy to increase separation between the prostate and rectum.
Medicare pays $3,392.28 for 55874 in the office in Iowa (Iowa). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 55874 covers
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.
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 in Iowa
| Payment locality | Office | Facility |
|---|---|---|
| Iowa | $3,392.28 | $133.16 |
How the 55874 rate is calculated
Each of 55874’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 55874
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.95Practice expense 107.63Malpractice 0.33
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 55874
The CMS indicators that decide how 55874 is paid alongside other services.
CMS payment indicators · 55874
Prostate spacer
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 1 | Permitted with supporting documentation. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
55874 without 51 · national office
$3,704.49
Prostate spacer
55874-51 · Second procedure: 50%
$1,852.25
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
55874 compared with similar codes
Compare codes
55874 vs 55876 vs 55875 vs 55873: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 55876Prostate markers
- Use 55874 for biodegradable material placed around the prostate to create separation from the rectum; use 55876 for placement of radiation-localization markers.
- 55875Prostate brachytherapy
- 55875 covers transperineal placement of needles or catheters for prostate brachytherapy, rather than placement of a biodegradable spacer.
- 55873Prostate cryoablation
- 55873 reports prostate cryoablation. It describes treatment of prostate tissue, not spacer placement before radiation.
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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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