Billing code 55815: Radical prostatectomyMedicare rate & RVUs in Virginia
Reports radical prostate removal through a perineal approach with bilateral pelvic lymphadenectomy, including the specified pelvic nodal regions.
CMS doesn’t publish an office rate for 55815 in Virginia.
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 55815 covers
This code describes radical removal of the prostate through an incision in the perineum, combined with lymph node dissection on both sides of the pelvis. The nodal work includes the external iliac, hypogastric, and obturator regions. A urologist typically performs the operation in a surgical setting for prostate cancer when this perineal approach and bilateral dissection are selected.
Choose this code when the operative report supports both the radical perineal prostatectomy and bilateral pelvic lymphadenectomy; perineal prostatectomy with only node biopsies is a different level of service. The code is priced as bilateral, so modifier 50 does not increase payment. It has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation. 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.
Where 55815 pays more and less in Virginia
| Payment locality | Office | Facility |
|---|---|---|
| Dc + Md/Va Suburbs | Unavailable | $1,700.15 |
| Virginia | Unavailable | $1,517.28 |
How the 55815 rate is calculated
Each of 55815’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 · 55815
RVUs × geographic indexes × conversion factor
Work32.13
32.13 RVUs× 1.000 GPCI
Practice expense10.56
10.56 RVUs× 1.000 GPCI
Malpractice4.13
4.13 RVUs× 1.000 GPCI
Adjusted RVUs
46.8200
Conversion factor
$33.4009
Medicare rate
$1,563.83
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 55815
55815 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 55815
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) | 2 | Already bilateral by definition: paid once at 100%. |
| 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 · 55815
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
55815 without 51 · national facility
$1,563.83
Radical prostatectomy
55815-51 · Second procedure: 50%
$781.92
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%).
55815 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 55810Radical prostatectomy
- Both describe radical perineal prostatectomy, but 55815 includes bilateral pelvic lymphadenectomy. Select 55810 when that nodal dissection is not performed.
- 55812Radical prostatectomy
- 55812 represents perineal radical prostatectomy with lymph node biopsies. Use 55815 when the documented nodal work is bilateral pelvic lymphadenectomy.
- 55845Radical prostatectomy
- Both include radical prostatectomy and bilateral pelvic lymphadenectomy; 55845 uses a retropubic approach, while 55815 uses a perineal approach.
- 55866Prostatectomy
- 55866 describes a laparoscopic retropubic radical prostatectomy. Distinguish it from 55815 by the documented operative approach and included service.
55815 billing questions
How does this differ from 55812?
55815 represents bilateral pelvic lymphadenectomy with radical perineal prostatectomy. 55812 is the perineal radical procedure with lymph node biopsies, rather than the bilateral dissection represented by 55815.
Can the pelvic lymphadenectomy be billed separately?
The bilateral pelvic lymphadenectomy is included in 55815. The operative report should support the bilateral dissection and the nodal regions addressed.
Should modifier 50 be appended?
The code is already priced as bilateral, and modifier 50 does not increase payment.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.
What happens when another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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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