No office rate
Both describe open retropubic radical prostate removal, but 55840 does not include the extensive bilateral pelvic node dissection represented by 55845.
On this page
CMS RVU26D · Effective 2026-10-01
55845 Radical prostatectomy Medicare reimbursement rates in Pennsylvania
Reports open retropubic radical prostate removal with bilateral dissection of the external iliac, hypogastric, and obturator lymph-node basins. Compare 55845 office and facility rates across CMS payment localities in Pennsylvania.
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 55845 in Pennsylvania?
Pennsylvania 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
$1180.37–$1256.27
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 55845: Open radical prostatectomy with extensive node dissection
Reports open retropubic radical prostate removal with bilateral dissection of the external iliac, hypogastric, and obturator lymph-node basins.
A urologist uses an open retropubic approach to remove the prostate for cancer and dissect pelvic lymph nodes on both sides, including the external iliac, hypogastric, and obturator basins. The code fits an operation that includes this extensive nodal dissection, rather than prostate removal alone or a less extensive node dissection. These procedures are generally performed in a hospital operating room.
Report the code when the operative note supports the retropubic approach, radical prostate removal, bilateral dissection, and the specified nodal basins. The bilateral work is built into the code; modifier 50 does not increase payment. The day-before preoperative visit and 90 days of related postoperative care are included in the global period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others are subject to the standard 50% reduction. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 55845
- 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
- The code is already priced as bilateral; modifier 50 does not increase payment.
- 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 RVU24.55 · 68%
- Practice expense (office) RVU8.49 · 23%
- Malpractice RVU3.17 · 9%
492
Medicare services in 2024 · #3582 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.
55845 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
No office rate
Use 55842 for a more limited bilateral pelvic node dissection. Use 55845 when the documented dissection includes the external iliac, hypogastric, and obturator basins.
No office rate
This is the perineal approach with extensive bilateral pelvic node dissection; 55845 is the retropubic approach.
No office rate
This code is for laparoscopic radical prostatectomy, including robotic assistance; 55845 describes an open retropubic operation.
Compare 55845 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
Metropolitan Philadelphia →
Office / nonfacility
Unavailable
Facility
$1256.27
Rest Of Pennsylvania →
Office / nonfacility
Unavailable
Facility
$1180.37
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.
55845 billing questions
How does this differ from 55842?
55845 is for the more extensive bilateral nodal dissection that includes the external iliac, hypogastric, and obturator basins. Use 55842 when the documented bilateral pelvic dissection is more limited.
Should modifier 50 be added for the bilateral dissection?
No. The code is priced for bilateral work, and modifier 50 does not increase payment.
Can the lymph-node dissection be billed separately?
The bilateral dissection of the specified pelvic basins is included in this procedure. The operative note should establish the extent of nodal work supporting this code.
What postoperative care is included?
The 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 made. Co-surgeon payment requires supporting documentation, and team-surgery payment is not permitted for this code.
How is this distinguished from 55866?
55845 describes an open retropubic operation. Code 55866 is for a laparoscopic radical prostatectomy, including when performed with robotic assistance.
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.
6,37955831,,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
6,38255845,,Extensive prostate surgery,A,,24.55,8.49,NA,8.49,,3.17,36.21,36.21,0,090,0.10,0.80,0.10,2,2,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,38355860,,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