Billing code 55860: Prostate exposureMedicare rate & RVUs in Washington
Reports surgical access to the prostate for treatment of localized prostate cancer, whether or not a biopsy is performed during the exposure.
CMS doesn’t publish an office rate for 55860 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 55860 covers
A urologist surgically exposes the prostate to enable treatment of localized prostate cancer. The approach may vary, and a biopsy may be performed during the same service. This code describes the exposure for treatment, rather than removal of the prostate or a percutaneous prostate procedure. It is generally performed in an operating room, with the operative report identifying the approach, the cancer-treatment purpose, and any biopsy performed.
Report the code when the documented service is surgical exposure for localized cancer treatment; the biopsy, if performed as part of that exposure, is included. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures are performed in the same session, Medicare pays the highest-valued procedure in full and reduces the others to 50%. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery; 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.
Where 55860 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $787.64 |
| Seattle (King Cnty) | Unavailable | $845.93 |
How the 55860 rate is calculated
Each of 55860’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 · 55860
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 15.44Practice expense 6.11Malpractice 1.98
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 55860
55860 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 55860
Prostate exposure
| 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) | 1 | Not paid (statutory restriction). |
| 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 · 55860
Prostate exposure
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
55860 without 51 · national facility
$785.92
Prostate exposure
55860-51 · Second procedure: 50%
$392.96
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%).
55860 compared with similar codes
Compare codes
55860 vs 55862 vs 55840 vs 55875: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 55862Radical prostatectomy
- Choose 55862 when the surgical exposure includes insertion of radioactive seeds. Code 55860 covers exposure for localized cancer treatment with or without biopsy, without that seed-insertion distinction.
- 55840Radical prostatectomy
- 55840 reports retropubic radical prostatectomy, which removes the prostate. 55860 is for surgical exposure to enable treatment and does not describe prostate removal.
- 55875Prostate brachytherapy
- 55875 describes transperineal placement of needles or catheters into the prostate. Use 55860 when the documented service is surgical exposure for localized cancer treatment.
55860 billing questions
How is this code different from 55862?
Use 55860 for surgical exposure for localized prostate cancer treatment, with or without biopsy. Code 55862 describes exposure that includes insertion of radioactive seeds.
Can a biopsy performed during the exposure be billed separately?
The code includes the exposure whether or not a biopsy is performed. A biopsy that is part of that service is not separately reported as additional work.
Should modifier 50 be used for bilateral work?
No. Modifier 50 is inappropriate for this code; the surgical exposure is reported as one service.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeons are payable only when supporting documentation is provided; team surgery is not permitted.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care through 90 days after surgery.
How does Medicare handle another procedure performed in the same session?
Under the standard multiple procedure reduction, Medicare pays the highest-valued procedure in full and reduces the other procedures to 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
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