No office rate
Both describe radical prostatectomy, but 55810 uses a perineal approach and 55840 uses a retropubic approach.
On this page
CMS RVU26D · Effective 2026-10-01
55810 Radical prostatectomy Medicare reimbursement rates in Maine
Reports radical removal of the prostate through a perineal approach, typically for prostate cancer when the operative plan uses this route. Compare 55810 office and facility rates across CMS payment localities in Maine.
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 55810 in Maine?
Maine has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1104.84–$1125.10
2 of 2 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.
Urology surgery
About 55810: Perineal radical prostatectomy
Reports radical removal of the prostate through a perineal approach, typically for prostate cancer when the operative plan uses this route.
A urologist removes the prostate through an incision in the perineum as treatment for prostate cancer. Radical prostatectomy includes removal of the prostate and seminal vesicles; nerve-sparing may be performed when clinically appropriate. This is a major operation performed in an operating room, generally in a hospital or other surgical facility.
Choose this code for the perineal approach when the operation is radical and the documented extent matches this code rather than a code that includes pelvic lymph node work. The operative report should identify the approach, the structures removed, and any nerve-sparing or lymph node procedures. CMS assigns a 90-day global period, including 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% 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 55810
- 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 RVU23.68 · 68%
- Practice expense (office) RVU8.16 · 23%
- Malpractice RVU3.04 · 9%
26
Medicare services in 2024 · #5764 by national volume
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.
55810 compared with similar codes
Office rates for Maine, from the same CMS release.
No office rate
This is a perineal radical prostatectomy sibling distinguished by lymph node work. Match the code to the documented extent of the operation.
No office rate
This sibling code describes perineal radical prostatectomy with a different extent of pelvic lymph node work; 55810 is for the operation without that added extent.
Compare 55810 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.
2 of 2 payment localities
Rest Of Maine →
Office / nonfacility
Unavailable
Facility
$1104.84
Southern Maine →
Office / nonfacility
Unavailable
Facility
$1125.10
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55810 billing questions
How does 55810 differ from 55840?
55810 is the perineal approach. 55840 is the retropubic approach to radical prostatectomy.
When should a code that includes lymph node work be used instead?
Use the applicable sibling code when pelvic lymph node biopsy or dissection is part of the operation. The operative report should support the extent of that work.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code because the descriptor or anatomy does not support modifier 50.
What postoperative care is included in the global period?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
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.
6,37255720,,Drainage of prostate abscess,A,,7.54,3.91,NA,3.91,,0.98,12.43,12.43,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,37355725,,Drainage of prostate abscess,A,,9.80,5.30,NA,5.30,,1.27,16.37,16.37,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,37455801,,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