How much does Medicare pay for CPT 55867?

Medicare allowed an average of $806.65 per service and paid $639.02 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $2865.98, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 55867?

Simple surgical subtotal removal of prostate using laparoscope. It was billed 1,476 times to 1,476 Medicare beneficiaries by 87 providers in 2024.

Which specialty bills 55867 most?

Urology, with 1,228 services from 70 clinicians. Next are Physician Assistant, Nurse Practitioner.

CPT 55867

Simple surgical subtotal removal of prostate using laparoscope

$806.65Medicare-allowed amount per service, averaged across 1,476 services

Providers submitted

$2865.98

Asking price, not received

Medicare allowed

$806.65

The fee schedule figure

Medicare paid

$639.02

Balance is patient coinsurance

Providers submitted an average of $2865.98 for this code and Medicare allowed $806.65 — 3.6× 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 $639.02 (79%); the rest is the patient’s coinsurance and deductible.

Services: 1,476
Beneficiaries: 1,476
Providers billing it: 87
Total allowed: $1,190,615

What Medicare pays for CPT 55867

Across 1,476 services billed by 87 providers to 1,476 beneficiaries, Medicare allowed an average of $806.65 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 55867

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	1,228	1,228	$941.95	70
Physician Assistant	236	236	$136.53	16
Nurse Practitioner	12	12	$139.68	1

55867 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	263	$739.34	$536.62	18
Texas	160	$785.22	$598.51	7
Maryland	123	$954.22	$698.75	2
Colorado	101	$527.62	$379.69	5
Utah	77	$811.02	$684.07	4
Florida	72	$1057.91	$801.88	5
Idaho	69	$537.20	$407.99	3
Tennessee	61	$693.89	$562.56	4
Oklahoma	59	$859.33	$663.53	4
Washington	56	$888.37	$650.60	4
Ohio	47	$991.36	$817.35	3
Pennsylvania	45	$1090.22	$792.99	3
Virginia	41	$1021.07	$777.30	3
New Jersey	39	$1067.68	$760.28	2
South Carolina	36	$990.21	$811.76	3
Iowa	26	$858.10	$718.20	2
Massachusetts	24	$848.55	$654.25	2
North Carolina	24	$586.90	$462.24	2
Arizona	20	$954.55	$766.93	1
Arkansas	17	$942.40	$798.74	1
Georgia	17	$869.16	$723.10	1
Indiana	16	$541.07	$390.58	1
New York	15	$1150.03	$803.64	1
Missouri	12	$1060.34	$812.28	1
South Dakota	12	$131.48	$55.31	1
Illinois	11	$1032.87	$813.29	1
Kansas	11	$129.87	$65.21	1
Nebraska	11	$501.30	$400.75	1
Oregon	11	$131.68	$56.40	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
55866Surgical removal of prostate and surrounding lymph nodes$946.38
55875Insertion of needle or tube into prostate for radiation therapy$1277.49

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.