Billing code 55801: ProstatectomyMedicare rate & RVUs in Washington
Reports open perineal removal of part of the prostate, typically to relieve obstruction from benign enlargement while preserving prostate tissue.
CMS doesn’t publish an office rate for 55801 in Washington.
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 55801 covers
A urologist performs this open operation through an incision in the perineum to remove the obstructing portion of the prostate rather than the entire gland. It is generally associated with treatment of benign prostatic enlargement causing urinary obstruction. The service includes related operative work such as control of postoperative bleeding, vasectomy, meatotomy, urethral calibration or dilation, and internal urethrotomy when performed as part of the operation; removal of seminal vesicles may or may not be included. It is typically performed in a facility operating room.
Report 55801 when the documented approach is perineal and the prostate removal is subtotal, not a radical excision. The operative report should establish the approach, extent of tissue removal, and indication. CMS assigns 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%. Modifier 50 is inappropriate for this single prostate operation. An assistant at surgery may be paid; co-surgeons require 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.
Where 55801 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $985.45 |
| Seattle (King Cnty) | Unavailable | $1,058.41 |
How the 55801 rate is calculated
Each of 55801’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 · 55801
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 19.31Practice expense 7.65Malpractice 2.48
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 55801
55801 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 55801
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 · 55801
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
55801 without 51 · national facility
$983.32
Prostatectomy
55801-51 · Second procedure: 50%
$491.66
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%).
55801 compared with similar codes
Compare codes
55801 vs 55810 vs 55821 vs 55831: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 55810Radical prostatectomy
- Both use a perineal approach, but 55801 describes subtotal removal, whereas 55810 is for radical prostate removal.
- 55821Prostatectomy
- Both describe subtotal prostate removal; choose 55801 for the perineal approach and 55821 for the retropubic approach.
- 55831Prostatectomy
- Both describe subtotal prostate removal; 55801 is perineal, while 55831 uses a suprapubic approach.
55801 billing questions
How does 55801 differ from a radical perineal prostatectomy?
55801 is for subtotal removal, typically addressing obstructing tissue while preserving prostate tissue. A radical perineal procedure removes the prostate as a cancer operation.
Which approach distinguishes 55801 from other subtotal prostatectomy codes?
The perineal approach supports 55801. Retropubic and suprapubic subtotal procedures are reported with their respective codes instead.
Can related urethral procedures be billed separately?
Control of postoperative bleeding, vasectomy, meatotomy, urethral calibration or dilation, and internal urethrotomy are included when performed as part of this operation.
Should modifier 50 be appended?
No. The prostate is a single organ for this procedure, and CMS identifies bilateral adjustment as inappropriate.
What global period and same-session reduction apply?
The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. In a session with multiple procedures, the highest-valued procedure is paid in full and others at 50%.
What support is needed for an assistant or co-surgeon?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation, while team surgery is not permitted.
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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