How much does Medicare pay for CPT 55875?

Medicare allowed an average of $1277.49 per service and paid $1015.63 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $5355.47, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 55875?

Insertion of needle or tube into prostate for radiation therapy. It was billed 2,756 times to 2,408 Medicare beneficiaries by 110 providers in 2024.

Does 55875 pay differently in an office than a hospital?

Yes. The allowed amount averaged $757.29 in an office setting and $1305.33 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 55875 most?

Radiation Oncology, with 1,228 services from 44 clinicians. Next are Urology, Ambulatory Surgical Center.

CPT 55875

Insertion of needle or tube into prostate for radiation therapy

$1277.49Medicare-allowed amount per service, averaged across 2,756 services

Providers submitted

$5355.47

Asking price, not received

Medicare allowed

$1277.49

The fee schedule figure

Medicare paid

$1015.63

Balance is patient coinsurance

Providers submitted an average of $5355.47 for this code and Medicare allowed $1277.49 — 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 $1015.63 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $757.29
Hospital / facility: $1305.33

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 140 services were billed in an office setting and 2,616 in a facility.

Services: 2,756
Beneficiaries: 2,408
Providers billing it: 110
Total allowed: $3,520,762

What Medicare pays for CPT 55875

Across 2,756 services billed by 110 providers to 2,408 beneficiaries, Medicare allowed an average of $1277.49 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 55875

Specialty	Services	Beneficiaries	Avg allowed	Providers
Radiation Oncology	1,228	1,025	$791.72	44
Urology	769	696	$767.32	41
Ambulatory Surgical Center	759	687	$2580.33	25

55875 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	883	$1642.44	$1091.90	24
New York	196	$869.79	$592.95	7
Florida	188	$1273.16	$1031.01	8
Ohio	180	$922.50	$738.64	9
Delaware	139	$1614.34	$1276.93	6
Texas	124	$879.59	$705.50	6
Georgia	116	$1457.57	$1178.85	4
Mississippi	106	$1312.70	$1238.64	5
Virginia	100	$1024.52	$815.06	6
Arizona	85	$1590.50	$1273.13	4
Utah	65	$1180.07	$951.14	3
Maryland	64	$1102.65	$853.41	4
Massachusetts	63	$816.71	$603.60	1
Kansas	59	$733.02	$598.68	3
Illinois	56	$1203.82	$951.83	4
Minnesota	44	$748.19	$595.67	2
Michigan	43	$743.55	$587.37	2
Pennsylvania	41	$800.02	$607.37	1
Wisconsin	30	$716.59	$605.35	2
Indiana	30	$715.17	$597.84	1
Nebraska	26	$1670.84	$1374.62	2
Iowa	21	$711.17	$605.97	1
Colorado	21	$770.06	$596.54	1
South Dakota	20	$729.57	$604.36	1
Hawaii	20	$2508.90	$1985.64	1
South Carolina	19	$691.01	$602.25	1
Wyoming	17	$752.99	$595.31	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
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.