CPT 55812
Global 090 ActiveExtensive prostate surgery
CPT 55812 Billing & Documentation Guide
CPT code 55812 (Extensive prostate surgery) is classified under Surgery (Urinary/Reproductive) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 29.14, a non-facility practice expense RVU of 9.94, and a malpractice RVU of 3.75, a total non-facility RVU of 42.83 and facility RVU of 42.83. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $1446.9, though rates vary from $1323 to $1882.55 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 55812, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 55812 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
90-day global period (major surgery: 1 day pre-op + procedure + 90 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 55812 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 55812
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 29.14 | 29.14 |
| Practice Expense RVU | 9.94 | 9.94 |
| Malpractice RVU | 3.75 | 3.75 |
| Total RVU | 42.83 | 42.83 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 55812
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $1468.96 | $1468.96 | $1420.86 - $1626.25 | 29 |
| Florida | $1550.24 | $1550.24 | $1478.95 - $1635.69 | 3 |
| Georgia | $1441.36 | $1441.36 | $1418.75 - $1463.97 | 2 |
| Illinois | $1536.87 | $1536.87 | $1472.19 - $1601.24 | 4 |
| Michigan | $1461.34 | $1461.34 | $1417.83 - $1504.86 | 2 |
| North Carolina | $1363.1 | $1363.1 | $1363.1 - $1363.1 | 1 |
| New York | $1560.12 | $1560.12 | $1376.76 - $1662.94 | 5 |
| Ohio | $1402.68 | $1402.68 | $1402.68 - $1402.68 | 1 |
| Pennsylvania | $1441.16 | $1441.16 | $1396.45 - $1485.87 | 2 |
| Texas | $1421.86 | $1421.86 | $1391.79 - $1483.12 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 55812
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 55812 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0403U | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0421T | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 0424U | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0433U | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 0582T | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
Frequently Asked Questions, CPT 55812
What does CPT code 55812 mean? +
CPT code 55812 represents: Extensive prostate surgery. It's in the Surgery (Urinary/Reproductive) category with a global period of 090.
What is the Medicare reimbursement for CPT 55812? +
The 2026 Medicare national average non-facility payment for CPT 55812 is $1446.9. Rates range from $1323 to $1882.55 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 55812? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 55812? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 2, 2026.
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