How much does Medicare pay for CPT 55866?

Medicare allowed an average of $946.38 per service and paid $751.11 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $5960.70, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 55866?

Surgical removal of prostate and surrounding lymph nodes using an endoscope. It was billed 13,739 times to 13,735 Medicare beneficiaries by 675 providers in 2024.

Does 55866 pay differently in an office than a hospital?

Yes. The allowed amount averaged $1221.64 in an office setting and $942.19 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 55866 most?

Urology, with 11,636 services from 580 clinicians. Next are Physician Assistant, Nurse Practitioner, General Surgery.

CPT 55866

Surgical removal of prostate and surrounding lymph nodes using an endoscope

$946.38Medicare-allowed amount per service, averaged across 13,739 services

Providers submitted

$5960.70

Asking price, not received

Medicare allowed

$946.38

The fee schedule figure

Medicare paid

$751.11

Balance is patient coinsurance

Providers submitted an average of $5960.70 for this code and Medicare allowed $946.38 — 6.3× 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 $751.11 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $1221.64
Hospital / facility: $942.19

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 206 services were billed in an office setting and 13,533 in a facility.

Services: 13,739
Beneficiaries: 13,735
Providers billing it: 675
Total allowed: $13,002,315

What Medicare pays for CPT 55866

Across 13,739 services billed by 675 providers to 13,735 beneficiaries, Medicare allowed an average of $946.38 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 55866

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	11,636	11,632	$1087.10	580
Physician Assistant	1,793	1,793	$157.96	78
Nurse Practitioner	241	241	$157.64	14
General Surgery	51	51	$566.35	2
Certified Clinical Nurse Specialist	18	18	$151.13	1

55866 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	1,858	$942.33	$686.64	89
Florida	1,265	$890.62	$659.48	41
New York	957	$1033.35	$725.54	37
Texas	952	$972.35	$762.33	47
Ohio	628	$907.79	$721.17	22
Pennsylvania	531	$1077.73	$824.47	27
Illinois	521	$1107.62	$823.53	24
Tennessee	417	$875.26	$720.53	18
Washington	405	$821.78	$619.80	22
Minnesota	318	$977.82	$770.42	12
Georgia	318	$1049.19	$829.72	20
Virginia	307	$1123.99	$898.10	19
North Carolina	292	$836.97	$669.82	16
Maryland	282	$1085.32	$815.53	14
Massachusetts	264	$1003.35	$732.26	12
Wisconsin	255	$940.78	$788.17	15
South Dakota	252	$603.52	$476.38	17
Arizona	249	$1077.76	$869.86	14
Indiana	247	$989.39	$839.01	14
South Carolina	236	$949.83	$774.17	12
Kansas	231	$862.60	$706.17	13
Oregon	230	$851.91	$652.13	14
Nebraska	199	$643.96	$532.81	13
Colorado	189	$998.60	$809.74	10
Oklahoma	189	$868.07	$692.35	11
New Jersey	182	$962.51	$717.11	11
Missouri	164	$958.29	$743.17	12
Alabama	163	$567.77	$445.17	7
Utah	160	$597.62	$460.72	6
District of Columbia	145	$1252.37	$867.44	6
Nevada	141	$743.16	$584.72	6
Mississippi	138	$1037.74	$855.85	7
Iowa	132	$921.00	$781.10	9
Michigan	129	$1172.06	$879.45	9
Arkansas	127	$1049.19	$902.56	7
Idaho	127	$605.81	$477.60	8
Louisiana	98	$849.58	$655.56	6
Montana	97	$990.83	$768.14	7
New Hampshire	91	$1120.83	$906.10	4
Connecticut	75	$1003.43	$721.88	5
Kentucky	67	$1095.94	$885.29	5
Vermont	21	$1068.93	$927.88	1
North Dakota	19	$1124.11	$926.44	1
Delaware	18	$1217.69	$913.42	1
West Virginia	18	$1199.99	$916.15	1
Alaska	13	$636.44	$325.06	1
Rhode Island	11	$1117.17	$946.94	1
Hawaii	11	$1087.89	$927.08	1

Related codes

55876Placement of device in prostate for radiation therapy$195.82
55874Injection of biodegradable material next to prostate$1609.52
55899Other procedure on male genital system$256.22
55875Insertion of needle or tube into prostate for radiation therapy$1277.49
55867Simple surgical subtotal removal of prostate$806.65

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.