Billing code 55862: Radical prostatectomyMedicare rate & RVUs in Utah
Reports retropubic removal of the prostate for malignancy with nerve sparing and bilateral pelvic lymph node dissection during the same operation.
CMS doesn’t publish an office rate for 55862 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 55862 covers
A urologist performs this open retropubic operation to remove the prostate, preserve the neurovascular bundles when feasible, and dissect pelvic lymph nodes on both sides. It is used in the surgical treatment of prostate cancer. The operative record should identify the approach, prostate removal, nerve-sparing work, and bilateral lymph node dissection performed.
Report one unit for the completed operation. The documentation should support the full service rather than prostate removal alone or a separate node procedure. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during the 90 days after surgery. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted. Modifier 50 is inappropriate for this code.
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.
55862 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | Unavailable | $958.08 |
How the 55862 rate is calculated
Each of 55862’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 · 55862
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 19.54Practice expense 7.33Malpractice 2.51
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 55862
55862 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 55862
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 · 55862
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
55862 without 51 · national facility
$981.32
Radical prostatectomy
55862-51 · Second procedure: 50%
$490.66
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%).
55862 compared with similar codes
Compare codes
55862 vs 55812 vs 55842 vs 55845 vs 55866: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 55812Radical prostatectomy
- 55812 describes retropubic radical prostatectomy without the bilateral pelvic lymphadenectomy included in 55862. Choose based on the operation actually documented.
- 55842Radical prostatectomy
- Both describe retropubic radical prostatectomy with bilateral pelvic lymphadenectomy. Distinguish 55862 by its nerve-sparing service.
- 55845Radical prostatectomy
- 55845 represents a related retropubic operation with a more extensive pelvic node dissection. Use the code matching the documented extent and components.
- 55866Prostatectomy
- 55866 describes a laparoscopic radical prostatectomy; 55862 is the open retropubic service. Select by operative approach.
55862 billing questions
How does this differ from a radical prostatectomy without lymphadenectomy?
Report 55862 when the retropubic radical prostatectomy includes bilateral pelvic lymph node dissection and the nerve-sparing work represented by this code. A prostatectomy without the documented node dissection is not this service.
Can the pelvic lymph node dissection be billed separately?
The bilateral node dissection is part of this combined prostate operation. Do not report it again as a separate service for the same operative work.
Should modifier 50 be appended for bilateral node dissection?
No. CMS identifies bilateral adjustment as inappropriate for this code; bilateral dissection is included in the service.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
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 procedures in the same session paid?
Under the standard multiple-procedure rule, the highest-valued procedure is paid in full and other procedures are subject to a 50% 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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