No office rate
Both are subtotal prostatectomies; choose 55801 for the perineal route and 55821 for the suprapubic route through the bladder.
On this page
CMS RVU26D · Effective 2026-10-01
55821 Prostatectomy Medicare reimbursement rates in Missouri
Reports open suprapubic removal of obstructing prostate tissue while leaving the prostate capsule, commonly for benign enlargement causing urinary symptoms. Compare 55821 office and facility rates across CMS payment localities in Missouri.
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 55821 in Missouri?
Missouri has 3 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 3 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$726.34–$745.86
3 of 3 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 55821 pays more and less in Missouri
Urologic surgery
About 55821: Suprapubic subtotal prostatectomy
Reports open suprapubic removal of obstructing prostate tissue while leaving the prostate capsule, commonly for benign enlargement causing urinary symptoms.
A urologist performs this open operation through a lower abdominal incision and an opening into the bladder to remove the obstructing portion of the prostate. It is generally used for substantial benign prostatic enlargement, such as when urinary obstruction requires surgical treatment. The prostate capsule remains, distinguishing this subtotal operation from radical prostatectomy for cancer. The procedure is typically performed in a hospital operating room.
Select the code when the operative report supports the suprapubic route and subtotal removal, rather than a perineal or retropubic approach or radical cancer surgery. The report should identify the approach, extent of removal, and indication. Associated services specified as included in the code, such as cystourethroscopy, urethral dilation, or control of postoperative bleeding, are not separately reported as components of this operation. It has a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 55821
- 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 RVU14.80 · 65%
- Practice expense (office) RVU5.90 · 26%
- Malpractice RVU1.91 · 8%
376
Medicare services in 2024 · #3790 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.
55821 compared with similar codes
Office rates for Missouri, from the same CMS release.
No office rate
This is the retropubic subtotal approach. Code 55821 describes the suprapubic approach.
No office rate
This code describes retropubic radical prostatectomy, a different extent of surgery. Code 55821 is subtotal removal for conditions such as benign enlargement.
No office rate
This code represents transurethral prostate resection, not open suprapubic subtotal prostate removal.
Compare 55821 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.
3 of 3 payment localities
Metropolitan Kansas City →
Office / nonfacility
Unavailable
Facility
$741.71
Metropolitan St. Louis →
Office / nonfacility
Unavailable
Facility
$745.86
Rest Of Missouri →
Office / nonfacility
Unavailable
Facility
$726.34
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55821 billing questions
How is this code different from 55831?
Both describe subtotal prostate removal, but 55821 is the suprapubic approach through the bladder. Code 55831 is the retropubic approach.
Can the included cystourethroscopy or urethral dilation be billed separately?
No, when performed as part of the prostatectomy services included in this code. The operative report should support the operation and its approach.
Should modifier 50 be appended?
No. Modifier 50 is inappropriate for this operation on the single prostate.
What documentation supports reporting 55821 instead of a radical prostatectomy code?
Document the suprapubic route and subtotal removal, including that the operation treats obstructing prostate tissue rather than removing the prostate radically for cancer.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures in the session are paid at 50%. The code has a 90-day global period.
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.
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.
6,37555810,,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
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