How much does Medicare pay for CPT 55899?

Medicare allowed an average of $256.22 per service and paid $201.54 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1285.43, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 55899?

Other procedure on male genital system. It was billed 14,882 times to 13,887 Medicare beneficiaries by 319 providers in 2024.

Does 55899 pay differently in an office than a hospital?

Yes. The allowed amount averaged $255.42 in an office setting and $333.91 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 55899 most?

Urology, with 14,403 services from 300 clinicians. Next are Nurse Practitioner, Physician Assistant, General Surgery.

CPT 55899

Other procedure on male genital system

$256.22Medicare-allowed amount per service, averaged across 14,882 services

Providers submitted

$1285.43

Asking price, not received

Medicare allowed

$256.22

The fee schedule figure

Medicare paid

$201.54

Balance is patient coinsurance

Providers submitted an average of $1285.43 for this code and Medicare allowed $256.22 — 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 $201.54 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $255.42
Hospital / facility: $333.91

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 14,730 services were billed in an office setting and 152 in a facility.

Services: 14,882
Beneficiaries: 13,887
Providers billing it: 319
Total allowed: $3,813,066

What Medicare pays for CPT 55899

Across 14,882 services billed by 319 providers to 13,887 beneficiaries, Medicare allowed an average of $256.22 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 55899

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	14,403	13,421	$257.39	300
Nurse Practitioner	287	280	$220.33	11
Physician Assistant	179	173	$223.42	7
General Surgery	13	13	$208.89	1

55899 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
New York	5,880	$321.60	$242.03	61
Illinois	1,879	$279.58	$210.94	55
Florida	1,403	$178.83	$135.77	27
Maryland	1,353	$175.99	$138.59	45
New Jersey	920	$187.54	$147.22	21
Texas	556	$176.72	$137.30	13
Pennsylvania	491	$188.10	$145.05	18
Virginia	443	$179.86	$137.25	10
Massachusetts	389	$282.72	$215.34	5
Georgia	336	$178.67	$139.37	10
Colorado	262	$158.41	$123.64	10
Louisiana	203	$144.01	$108.72	7
Ohio	111	$170.44	$135.10	5
Rhode Island	106	$267.76	$219.50	4
Connecticut	101	$309.97	$234.51	4
California	92	$354.34	$276.98	3
Minnesota	73	$275.48	$203.72	5
Arkansas	68	$137.78	$101.12	4
District of Columbia	44	$738.22	$588.18	1
Delaware	36	$152.16	$113.08	2
North Carolina	30	$86.87	$69.21	2
Utah	29	$329.09	$256.17	1
Wisconsin	28	$217.96	$173.42	2
Tennessee	22	$974.35	$730.51	2
South Carolina	14	$214.39	$160.00	1
New Hampshire	13	$221.86	$176.39	1

Related codes

55876Placement of device in prostate for radiation therapy$195.82
55874Injection of biodegradable material next to prostate$1609.52
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.