How much does Medicare pay for CPT 55700?

Medicare allowed an average of $311.10 per service and paid $241.16 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1319.67, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 55700?

Biopsy of prostate gland. It was billed 154,768 times to 153,594 Medicare beneficiaries by 4,580 providers in 2024.

Does 55700 pay differently in an office than a hospital?

Yes. The allowed amount averaged $229.29 in an office setting and $357.94 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 55700 most?

Urology, with 121,667 services from 4,209 clinicians. Next are Ambulatory Surgical Center, Nurse Practitioner, Physician Assistant.

CPT 55700

Biopsy of prostate gland

$311.10Medicare-allowed amount per service, averaged across 154,768 services

Providers submitted

$1319.67

Asking price, not received

Medicare allowed

$311.10

The fee schedule figure

Medicare paid

$241.16

Balance is patient coinsurance

Providers submitted an average of $1319.67 for this code and Medicare allowed $311.10 — 4.2× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $241.16 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $229.29
Hospital / facility: $357.94

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 56,354 services were billed in an office setting and 98,414 in a facility.

Services: 154,768
Beneficiaries: 153,594
Providers billing it: 4,580
Total allowed: $48,148,325

What Medicare pays for CPT 55700

Across 154,768 services billed by 4,580 providers to 153,594 beneficiaries, Medicare allowed an average of $311.10 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 55700

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	121,667	120,741	$173.15	4,209
Ambulatory Surgical Center	30,272	30,033	$880.33	280
Nurse Practitioner	969	966	$138.41	19
Physician Assistant	873	871	$164.31	32
Diagnostic Radiology	526	522	$144.14	23
Radiation Oncology	164	164	$189.92	5
General Surgery	138	138	$175.85	5
Interventional Radiology	57	57	$119.92	3
Internal Medicine	41	41	$127.29	1
Hematology-Oncology	25	25	$252.61	1
Osteopathic Manipulative Medicine	20	20	$117.22	1
Surgical Oncology	16	16	$144.64	1

55700 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	12,645	$297.45	$199.64	392
Florida	11,048	$340.96	$277.43	341
Texas	8,937	$311.94	$249.54	281
New York	8,703	$270.46	$188.76	248
Pennsylvania	8,366	$335.57	$263.20	221
Maryland	7,465	$510.75	$405.92	136
Illinois	6,748	$270.18	$201.85	188
Ohio	6,323	$289.06	$235.72	176
Georgia	5,799	$388.75	$314.48	175
New Jersey	5,420	$404.49	$297.50	165
Tennessee	5,165	$355.24	$307.10	114
Virginia	5,112	$336.80	$274.97	127
Arizona	3,889	$309.25	$245.70	110
Massachusetts	3,857	$238.69	$175.56	123
South Carolina	3,847	$289.55	$237.52	99
Indiana	3,436	$221.30	$177.48	116
North Carolina	3,342	$191.43	$149.45	137
Washington	2,924	$282.27	$204.04	95
Michigan	2,706	$222.13	$170.97	114
Mississippi	2,671	$355.51	$317.07	57
Colorado	2,584	$348.33	$268.37	82
Kansas	2,578	$331.11	$282.99	50
Missouri	2,458	$259.53	$208.46	89
Nebraska	2,224	$432.61	$354.66	45
Kentucky	2,112	$429.21	$356.61	51
Minnesota	2,028	$221.41	$171.47	64
Arkansas	1,993	$365.22	$309.54	43
Wisconsin	1,914	$232.75	$188.49	82
Oklahoma	1,749	$205.23	$169.71	65
Alabama	1,527	$227.17	$196.65	65
Oregon	1,478	$322.70	$234.25	54
Louisiana	1,470	$174.64	$140.56	58
Iowa	1,300	$222.48	$184.79	50
South Dakota	1,180	$357.51	$308.83	21
Nevada	937	$370.38	$294.87	29
Connecticut	919	$214.00	$149.69	36
Delaware	914	$212.48	$155.06	20
Utah	811	$208.23	$166.62	34
Montana	805	$180.96	$130.89	23
New Hampshire	752	$163.89	$124.04	27
Idaho	702	$239.35	$199.52	26
West Virginia	556	$126.04	$94.53	23
Rhode Island	515	$312.80	$249.79	17
District of Columbia	429	$186.03	$127.23	13
New Mexico	408	$223.10	$172.54	18
North Dakota	404	$119.62	$94.21	12
Alaska	371	$263.92	$161.42	14
Wyoming	313	$227.73	$177.78	11
Maine	311	$142.34	$111.17	17
Vermont	285	$120.57	$91.67	12
Hawaii	208	$411.88	$313.57	9
U.S. Virgin Islands	89	$234.75	$187.40	2
ZZ	14	$123.36	$96.33	1
Guam	14	$261.80	$188.24	1
Puerto Rico	13	$232.87	$188.69	1

Related codes

55706Needle biopsy of prostate gland$669.08

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.