No office rate
Choose 55868 when lymph node biopsy accompanies the laparoscopic radical prostatectomy; 55866 is for the laparoscopic radical prostatectomy without that biopsy.
On this page
CMS RVU26D · Effective 2026-10-01
55868 Prostatectomy Medicare reimbursement rates in Kansas
Reports laparoscopic radical prostate removal with lymph node biopsy, including robotic assistance when performed, for a documented operative approach and nodal sampling. Compare 55868 office and facility rates across CMS payment localities in Kansas.
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 55868 in Kansas?
Kansas 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
$1034.39
1 of 1 localities have a supported rate.
Payment area: Kansas
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 55868: Laparoscopic radical prostatectomy with node biopsy
Reports laparoscopic radical prostate removal with lymph node biopsy, including robotic assistance when performed, for a documented operative approach and nodal sampling.
A urologist performs this laparoscopic operation to remove the prostate radically and biopsy lymph nodes during the same procedure, commonly in surgical treatment of prostate cancer. The approach may be conventional laparoscopy or robot-assisted; robotic assistance is part of the laparoscopic service when used. The operative report should identify the prostatectomy and the lymph node biopsy performed.
Select this code when the procedure includes lymph node biopsy; use the code for bilateral pelvic lymphadenectomy when that broader nodal procedure is performed instead. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 55868
- 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 RVU22.46 · 68%
- Practice expense (office) RVU7.79 · 23%
- Malpractice RVU2.91 · 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.
55868 compared with similar codes
Office rates for Kansas, from the same CMS release.
No office rate
55869 represents laparoscopic radical prostatectomy with bilateral pelvic lymphadenectomy. 55868 represents lymph node biopsy rather than that bilateral dissection.
No office rate
Both involve radical prostatectomy and bilateral pelvic nodal surgery, but 55845 is the open approach; 55868 is laparoscopic and describes lymph node biopsy.
Compare 55868 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
Kansas →
Office / nonfacility
Unavailable
Facility
$1034.39
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 55868 in Kansas.
PPRRVU2026_Oct_nonQPP.csv
6,388
- Code
- 55868
- Physician work
- 22.46
- Practice expense
- 7.79
- Malpractice
- 2.91
GPCI2026.csv
54
- Locality
- Kansas
- Physician work
- 1.000
- Practice expense
- 0.904
- Malpractice
- 0.504
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 22.46 | × 1.000 | 22.4600 |
| Practice expense | 7.79 | × 0.904 | 7.0422 |
| Malpractice | 2.91 | × 0.504 | 1.4666 |
| Total RVUs | 30.9688 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Kansas$1034.39
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 22.46 | 1 |
| Practice expense | 7.79 | 0.904 |
| Malpractice | 2.91 | 0.504 |
(22.46 × 1 + 7.79 × 0.904 + 2.91 × 0.504) × $33.4009 = $1034.39
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.
55868 billing questions
How does this differ from 55866?
Use 55868 when the laparoscopic radical prostatectomy includes lymph node biopsy. Code 55866 describes the laparoscopic radical prostatectomy without that biopsy.
When is 55869 a better fit?
Use 55869 for the laparoscopic radical prostatectomy with bilateral pelvic lymphadenectomy. This code is for lymph node biopsy, not that broader bilateral dissection.
Should modifier 50 be appended for lymph node work on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; do not use modifier 50.
Is robotic assistance reported separately?
No. Robotic assistance, when performed, is included in the laparoscopic prostatectomy service.
What documentation supports reporting this code?
The operative report should establish the laparoscopic radical prostatectomy and the lymph node biopsy performed. It should distinguish biopsy from bilateral pelvic lymphadenectomy.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, with other procedures subject to the standard multiple-procedure reduction. Related postoperative care is included in the 90-day global period.
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.
6,38555865,,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
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
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
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958