Billing code 55869: ProstatectomyMedicare rate & RVUs in Ohio
Reports laparoscopic radical prostate removal with bilateral pelvic lymphadenectomy, typically performed by a urologist for prostate cancer.
CMS doesn’t publish an office rate for 55869 in Ohio.
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 55869 covers
A urologist performs this laparoscopic operation to remove the prostate and dissect lymph nodes on both sides of the pelvis. It is used in the surgical treatment of prostate cancer and is generally performed in an operating room. The operative report should establish that the prostatectomy was radical and that bilateral pelvic lymphadenectomy was performed; node sampling by biopsy alone is a different service.
Report this code for the combined laparoscopic procedure, rather than for a prostatectomy without the specified bilateral lymphadenectomy. CMS assigns a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 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.
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.
55869 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | Unavailable | $1,304.01 |
How the 55869 rate is calculated
Each of 55869’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 · 55869
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 27.41Practice expense 8.82Malpractice 3.55
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 55869
55869 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 55869
Prostatectomy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are 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) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.08/0.83/0.09 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 55869
Prostatectomy
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
55869 without 51 · national facility
$1,328.69
Prostatectomy
55869-51 · Second procedure: 50%
$664.35
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%).
55869 compared with similar codes
Compare codes
55869 vs 55866 vs 55868 vs 55845 vs 55867: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 55866Prostatectomy
- Choose 55869 when the laparoscopic radical prostatectomy includes bilateral pelvic lymphadenectomy. Code 55866 describes the laparoscopic radical prostatectomy without that specified lymphadenectomy.
- 55868Prostatectomy
- 55868 identifies laparoscopic prostatectomy with pelvic lymph node biopsy. This code identifies the operation with bilateral pelvic lymphadenectomy.
- 55845Radical prostatectomy
- Both describe radical prostatectomy with bilateral pelvic lymphadenectomy, but 55845 is the open operation and this code is laparoscopic.
- 55867Prostatectomy
- 55867 describes laparoscopic simple subtotal prostatectomy. This code is for a radical prostatectomy with bilateral pelvic lymphadenectomy.
55869 billing questions
How does this differ from 55866?
This code describes laparoscopic radical prostatectomy with bilateral pelvic lymphadenectomy. Code 55866 describes the laparoscopic radical prostatectomy without that bilateral lymphadenectomy specified.
Is bilateral lymphadenectomy included in this service?
Yes. Bilateral pelvic lymphadenectomy is part of the combined service represented by this code; the operative report should document the dissection.
Should modifier 50 be appended?
No. CMS identifies bilateral adjustment as inappropriate for this code because the descriptor or anatomy already accounts for the bilateral service.
What global period applies?
The code has a 90-day global period, including 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 made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
How are other same-session procedures paid?
Under the standard multiple-procedure rule, the highest-valued procedure is paid in full and other procedures performed in the same session are subject to a reduction.
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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