How much does Medicare pay for CPT 55874?

Medicare allowed an average of $1609.52 per service and paid $1281.55 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $7860.27, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 55874?

Injection of biodegradable material next to prostate. It was billed 17,446 times to 17,415 Medicare beneficiaries by 674 providers in 2024.

Does 55874 pay differently in an office than a hospital?

Yes. The allowed amount averaged $2619.76 in an office setting and $1024.63 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 55874 most?

Urology, with 7,388 services from 355 clinicians. Next are Radiation Oncology, Ambulatory Surgical Center, Diagnostic Radiology.

CPT 55874

Injection of biodegradable material next to prostate

$1609.52Medicare-allowed amount per service, averaged across 17,446 services

Providers submitted

$7860.27

Asking price, not received

Medicare allowed

$1609.52

The fee schedule figure

Medicare paid

$1281.55

Balance is patient coinsurance

Providers submitted an average of $7860.27 for this code and Medicare allowed $1609.52 — 4.9× 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 $1281.55 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $2619.76
Hospital / facility: $1024.63

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. 6,397 services were billed in an office setting and 11,049 in a facility.

Services: 17,446
Beneficiaries: 17,415
Providers billing it: 674
Total allowed: $28,079,686

What Medicare pays for CPT 55874

Across 17,446 services billed by 674 providers to 17,415 beneficiaries, Medicare allowed an average of $1609.52 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 55874

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	7,388	7,380	$1225.42	355
Radiation Oncology	6,251	6,235	$1330.65	208
Ambulatory Surgical Center	2,824	2,820	$3554.75	79
Diagnostic Radiology	536	536	$301.00	16
Interventional Radiology	296	296	$393.77	13
Radiation Therapy Center	104	104	$2898.05	1
Family Practice	29	26	$3030.70	1
Osteopathic Manipulative Medicine	18	18	$148.87	1

55874 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
Florida	1,534	$1748.03	$1471.86	66
Texas	1,418	$1776.14	$1437.29	51
New York	1,414	$1877.41	$1257.89	40
California	1,385	$1981.44	$1346.37	57
Pennsylvania	956	$1318.54	$1066.11	31
Illinois	839	$2026.88	$1597.18	27
Virginia	828	$968.70	$816.61	26
New Jersey	639	$2182.95	$1549.06	19
Tennessee	611	$2011.36	$1788.74	20
Ohio	573	$1963.19	$1193.37	21
Kansas	534	$1330.83	$1131.20	17
Maryland	458	$2345.81	$1815.41	19
South Carolina	413	$976.00	$1055.24	16
Arkansas	380	$1645.87	$1427.74	12
Washington	362	$1301.78	$947.32	16
Arizona	361	$1434.76	$1174.32	17
Missouri	326	$1181.30	$993.06	16
Massachusetts	300	$892.38	$631.72	13
North Carolina	284	$850.93	$699.27	13
Indiana	281	$1112.71	$971.37	10
Nevada	278	$2063.39	$1679.55	5
Oklahoma	274	$1640.11	$1445.38	14
Minnesota	248	$281.40	$218.74	8
Mississippi	226	$1785.39	$1603.73	7
Michigan	221	$429.39	$361.08	10
Georgia	221	$1286.72	$1055.92	14
Colorado	197	$1996.98	$1528.35	11
Wisconsin	180	$796.09	$646.65	12
Delaware	178	$1634.28	$1323.28	6
Nebraska	155	$2288.48	$1859.45	8
Louisiana	137	$1940.38	$1681.11	4
Kentucky	130	$1139.19	$1015.85	6
Connecticut	123	$432.44	$308.93	8
North Dakota	113	$1496.78	$1124.02	7
Utah	107	$154.01	$122.24	5
District of Columbia	103	$2603.31	$1669.64	3
Iowa	97	$505.28	$440.54	5
Rhode Island	90	$1558.71	$1239.40	6
South Dakota	84	$142.61	$115.42	4
Alabama	76	$1258.10	$1147.42	5
Oregon	60	$1759.75	$1368.74	4
Hawaii	50	$3420.29	$2431.41	3
Montana	39	$2934.86	$2214.69	2
Alaska	39	$2988.50	$2192.32	3
Guam	38	$3294.77	$2219.24	1
New Mexico	32	$163.38	$126.71	2
Idaho	29	$1425.96	$1188.21	2
West Virginia	25	$156.82	$122.62	2

Related codes

55876Placement of device in prostate for radiation therapy$195.82
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
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.