Billing code 55812: Radical prostatectomyMedicare rate & RVUs in Utah
Reports radical removal of the prostate through a perineal approach when bilateral pelvic lymphadenectomy is performed during the same operative service.
CMS doesn’t publish an office rate for 55812 in Utah.
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 55812 covers
This code describes radical prostate removal through an incision in the perineum, together with removal of lymph nodes from both sides of the pelvis. Urologists typically perform the operation in a hospital operating room for prostate cancer. The operative report should establish the perineal approach and document the bilateral lymphadenectomy performed as part of the surgical service.
Choose this code when both the perineal radical prostatectomy and bilateral pelvic lymphadenectomy are performed; a perineal radical prostatectomy without lymphadenectomy is a different code. The lymphadenectomy is included in this combined service, rather than separately reported as a second service for the same work. Medicare 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 is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this operation. Assistant-at-surgery payment may be made; 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.
55812 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | Unavailable | $1,397.86 |
How the 55812 rate is calculated
Each of 55812’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 · 55812
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 29.14Practice expense 9.94Malpractice 3.75
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 55812
55812 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 55812
Radical 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) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 55812
Radical 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
55812 without 51 · national facility
$1,430.56
Radical prostatectomy
55812-51 · Second procedure: 50%
$715.28
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%).
55812 compared with similar codes
Compare codes
55812 vs 55810 vs 55815 vs 55842 vs 55866: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 55810Radical prostatectomy
- Both describe perineal radical prostatectomy, but 55812 includes bilateral pelvic lymphadenectomy. Choose 55810 when that lymphadenectomy is not performed.
- 55815Radical prostatectomy
- This is a neighboring perineal prostatectomy code for a more specifically described extent of pelvic node dissection. Compare the operative report’s documented nodal extent when selecting between the codes.
- 55842Radical prostatectomy
- 55842 describes a retropubic radical prostatectomy with bilateral pelvic lymphadenectomy. 55812 is for the perineal approach.
- 55866Prostatectomy
- 55866 describes laparoscopic radical prostatectomy; 55812 describes the perineal operation with bilateral pelvic lymphadenectomy.
55812 billing questions
How does this differ from 55810?
55812 includes bilateral pelvic lymphadenectomy with the perineal radical prostatectomy. Use 55810 for the perineal radical prostatectomy without that lymphadenectomy.
Can the pelvic lymphadenectomy be billed separately?
The bilateral pelvic lymphadenectomy is included in 55812 when performed as part of this combined operation. The operative report should document the nodal work performed.
Should modifier 50 be appended?
No. Modifier 50 is inappropriate for this prostate operation; bilateral lymphadenectomy is part of the code’s described service.
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 made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What happens when another procedure is performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple procedure 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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