No office rate
Use 55840 for an open retropubic radical prostatectomy. Use 55866 when the radical procedure is performed laparoscopically.
On this page
CMS RVU26D · Effective 2026-10-01
55866 Prostatectomy Medicare reimbursement rates in New Jersey
Report this service for laparoscopic radical removal of the prostate, including nerve-sparing work and robotic assistance when used, typically for prostate cancer. Compare 55866 office and facility rates across CMS payment localities in New Jersey.
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 55866 in New Jersey?
New Jersey 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
$1143.82–$1175.30
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.
Urologic surgery
About 55866: Laparoscopic radical prostate removal
Report this service for laparoscopic radical removal of the prostate, including nerve-sparing work and robotic assistance when used, typically for prostate cancer.
A urologist removes the prostate through a laparoscopic approach, using small abdominal incisions and instruments to dissect and remove the gland. The operation may include preservation of the neurovascular bundles when clinically appropriate; robotic assistance is included when used. This approach is commonly selected for patients undergoing radical prostate surgery for prostate cancer, with most Medicare services performed in a facility.
Select this code for a radical laparoscopic prostatectomy, not a simple or subtotal prostate removal. The operative report should establish the laparoscopic approach, radical intent, structures removed, and any nerve-sparing work or robotic assistance. Medicare assigns a 90-day global period, including the day-before preoperative visit and 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. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 55866
- 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 RVU21.90 · 68%
- Practice expense (office) RVU7.66 · 24%
- Malpractice RVU2.83 · 9%
25.1K
Medicare services in 2024 · #1048 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.
55866 compared with similar codes
Office rates for New Jersey, from the same CMS release.
No office rate
55845 describes an open radical prostatectomy with bilateral pelvic lymphadenectomy. This code identifies the laparoscopic radical prostatectomy approach.
No office rate
55867 is for simple or subtotal prostate removal performed laparoscopically. This code is for radical prostate removal.
Compare 55866 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
Northern Nj →
Office / nonfacility
Unavailable
Facility
$1175.30
Rest Of New Jersey →
Office / nonfacility
Unavailable
Facility
$1143.82
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55866 billing questions
Does robotic assistance require a different code?
No. Robotic assistance, when used for this laparoscopic radical prostatectomy, is included in the service.
How does this differ from 55867?
55866 describes radical prostate removal; 55867 is for simple or subtotal prostate removal. Choose based on the operation performed, not whether a robot is used.
Should modifier 50 be reported?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this procedure.
What postoperative care is included?
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?
Assistant-at-surgery payment may be allowed. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
How are other same-session procedures paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
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.
6,38355860,,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
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