Billing code 55866: ProstatectomyMedicare rate & RVUs in Utah
Report this service for laparoscopic radical removal of the prostate, including nerve-sparing work and robotic assistance when used, typically for prostate cancer.
CMS doesn’t publish an office rate for 55866 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 55866 covers
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.
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 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | Unavailable | $1,056.86 |
How the 55866 rate is calculated
Each of 55866’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 · 55866
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 21.90Practice expense 7.66Malpractice 2.83
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 55866
55866 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 55866
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 · 55866
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
55866 without 51 · national facility
$1,081.86
Prostatectomy
55866-51 · Second procedure: 50%
$540.93
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%).
55866 compared with similar codes
Compare codes
55866 vs 55840 vs 55845 vs 55867: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 55840Radical prostatectomy
- Use 55840 for an open retropubic radical prostatectomy. Use 55866 when the radical procedure is performed laparoscopically.
- 55845Radical prostatectomy
- 55845 describes an open radical prostatectomy with bilateral pelvic lymphadenectomy. This code identifies the laparoscopic radical prostatectomy approach.
- 55867Prostatectomy
- 55867 is for simple or subtotal prostate removal performed laparoscopically. This code is for radical prostate removal.
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 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
Fee sheets
Put 55866 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →