No office rate
Both use a perineal approach, but 55801 describes subtotal removal, whereas 55810 is for radical prostate removal.
On this page
CMS RVU26D · Effective 2026-10-01
55801 Prostatectomy Medicare reimbursement rates in Wisconsin
Reports open perineal removal of part of the prostate, typically to relieve obstruction from benign enlargement while preserving prostate tissue. Compare 55801 office and facility rates across CMS payment localities in Wisconsin.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 55801 in Wisconsin?
Wisconsin has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$915.27
1 of 1 localities have a supported rate.
Payment area: Wisconsin
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Urologic surgery
About 55801: Perineal subtotal prostatectomy
Reports open perineal removal of part of the prostate, typically to relieve obstruction from benign enlargement while preserving prostate tissue.
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.
CMS billing rules for 55801
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU19.31 · 66%
- Practice expense (office) RVU7.65 · 26%
- Malpractice RVU2.48 · 8%
16
Medicare services in 2024 · #6041 by national volume
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.
55801 compared with similar codes
Office rates for Wisconsin, from the same CMS release.
No office rate
Both describe subtotal prostate removal; choose 55801 for the perineal approach and 55821 for the retropubic approach.
No office rate
Both describe subtotal prostate removal; 55801 is perineal, while 55831 uses a suprapubic approach.
Compare 55801 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Wisconsin →
Office / nonfacility
Unavailable
Facility
$915.27
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 55801 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
6,374
- Code
- 55801
- Physician work
- 19.31
- Practice expense
- 7.65
- Malpractice
- 2.48
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 19.31 | × 1.000 | 19.3100 |
| Practice expense | 7.65 | × 0.958 | 7.3287 |
| Malpractice | 2.48 | × 0.308 | 0.7638 |
| Total RVUs | 27.4025 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wisconsin$915.27
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 19.31 | 1 |
| Practice expense | 7.65 | 0.958 |
| Malpractice | 2.48 | 0.308 |
(19.31 × 1 + 7.65 × 0.958 + 2.48 × 0.308) × $33.4009 = $915.27
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
6,37155715,,Bx prst8 ea add mri-us/ct/mr,A,,1.05,1.24,,0.22,,0.14,2.43,1.41,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,37255720,,Drainage of prostate abscess,A,,7.54,3.91,NA,3.91,,0.98,12.43,12.43,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,37355725,,Drainage of prostate abscess,A,,9.80,5.30,NA,5.30,,1.27,16.37,16.37,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,37455801,,Removal of prostate,A,,19.31,7.65,NA,7.65,,2.48,29.44,29.44,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,37555810,,Extensive prostate surgery,A,,23.68,8.16,NA,8.16,,3.04,34.88,34.88,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,37655812,,Extensive prostate surgery,A,,29.14,9.94,NA,9.94,,3.75,42.83,42.83,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,37755815,,Extensive prostate surgery,A,,32.13,10.56,NA,10.56,,4.13,46.82,46.82,0,090,0.10,0.80,0.10,2,2,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,