How much does Medicare pay for CPT 55876?

Medicare allowed an average of $195.82 per service and paid $154.94 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $975.22, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 55876?

Placement of device in prostate for radiation therapy. It was billed 17,709 times to 17,657 Medicare beneficiaries by 669 providers in 2024.

Does 55876 pay differently in an office than a hospital?

Yes. The allowed amount averaged $91.68 in an office setting and $254.56 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 55876 most?

Urology, with 7,442 services from 348 clinicians. Next are Radiation Oncology, Ambulatory Surgical Center, Diagnostic Radiology.

CPT 55876

Placement of device in prostate for radiation therapy

$195.82Medicare-allowed amount per service, averaged across 17,709 services

Providers submitted

$975.22

Asking price, not received

Medicare allowed

$195.82

The fee schedule figure

Medicare paid

$154.94

Balance is patient coinsurance

Providers submitted an average of $975.22 for this code and Medicare allowed $195.82 — 5.0× 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 $154.94 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $91.68
Hospital / facility: $254.56

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 6,387 services were billed in an office setting and 11,322 in a facility.

Services: 17,709
Beneficiaries: 17,657
Providers billing it: 669
Total allowed: $3,467,776

What Medicare pays for CPT 55876

Across 17,709 services billed by 669 providers to 17,657 beneficiaries, Medicare allowed an average of $195.82 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 55876

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	7,442	7,429	$74.52	348
Radiation Oncology	6,356	6,324	$74.27	206
Ambulatory Surgical Center	2,766	2,763	$855.79	75
Diagnostic Radiology	566	566	$57.04	18
Interventional Radiology	330	330	$56.88	14
Nurse Practitioner	156	155	$93.78	3
Physician Assistant	53	53	$93.21	3
Family Practice	29	26	$77.38	1
Hematology-Oncology	11	11	$101.85	1

55876 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	1,504	$264.93	$239.38	59
New York	1,484	$150.21	$108.00	39
California	1,411	$125.17	$85.83	61
Texas	1,258	$258.10	$208.57	39
Pennsylvania	917	$302.94	$246.00	28
Virginia	866	$236.68	$197.03	24
Illinois	717	$128.61	$95.40	27
Tennessee	597	$270.84	$236.60	21
New Jersey	515	$173.11	$127.90	16
Kansas	514	$89.14	$89.81	17
Maryland	509	$336.52	$266.59	19
Massachusetts	509	$142.65	$103.83	21
Washington	480	$205.79	$147.77	17
Arizona	412	$227.39	$183.42	19
Missouri	405	$203.19	$167.24	17
South Carolina	402	$149.56	$124.93	17
Arkansas	378	$357.77	$306.53	12
Ohio	331	$78.36	$61.58	15
Colorado	324	$101.65	$79.06	16
Georgia	323	$124.68	$104.37	18
North Carolina	312	$128.60	$106.53	13
Oklahoma	296	$149.96	$128.00	13
Nevada	289	$399.57	$329.77	4
Mississippi	264	$398.46	$359.51	10
Minnesota	262	$57.08	$43.51	9
Michigan	230	$61.32	$46.71	10
Kentucky	229	$206.92	$178.59	12
Indiana	205	$60.78	$51.26	9
Delaware	178	$127.71	$99.53	6
Wisconsin	163	$108.82	$89.33	9
Nebraska	158	$557.59	$451.63	8
District of Columbia	155	$93.40	$62.02	5
Louisiana	125	$77.61	$64.59	4
North Dakota	117	$65.24	$51.08	7
Oregon	113	$162.98	$127.86	8
Connecticut	97	$58.48	$43.58	6
Rhode Island	94	$214.63	$246.36	6
Utah	88	$73.90	$45.32	5
Alabama	80	$92.14	$76.99	4
Iowa	68	$47.83	$40.81	3
New Hampshire	66	$91.66	$73.71	2
South Dakota	65	$49.30	$39.72	4
Hawaii	60	$112.74	$90.07	2
Idaho	50	$422.22	$350.04	3
Alaska	39	$88.94	$59.07	3
Guam	38	$82.03	$59.24	1
Montana	12	$57.36	$50.41	1

Related codes

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
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.