CPT 55840
Global 090 ActiveExtensive prostate surgery
CPT 55840 Billing & Documentation Guide
CPT code 55840 (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 20.83, a non-facility practice expense RVU of 7.74, and a malpractice RVU of 2.72, a total non-facility RVU of 31.29 and facility RVU of 31.29. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $1057.53, though rates vary from $964.6 to $1369 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 55840, 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 55840 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 55840 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 55840
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 20.83 | 20.83 |
| Practice Expense RVU | 7.74 | 7.74 |
| Malpractice RVU | 2.72 | 2.72 |
| Total RVU | 31.29 | 31.29 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 55840
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 | $1075.85 | $1075.85 | $1039.61 - $1193.76 | 29 |
| Florida | $1131.98 | $1131.98 | $1079.44 - $1194.62 | 3 |
| Georgia | $1052.12 | $1052.12 | $1034.64 - $1069.6 | 2 |
| Illinois | $1121.59 | $1121.59 | $1073.77 - $1168.93 | 4 |
| Michigan | $1066.37 | $1066.37 | $1034.34 - $1098.39 | 2 |
| North Carolina | $995 | $995 | $995 - $995 | 1 |
| New York | $1140.65 | $1140.65 | $1005.21 - $1216.36 | 5 |
| Ohio | $1023.35 | $1023.35 | $1023.35 - $1023.35 | 1 |
| Pennsylvania | $1052.35 | $1052.35 | $1018.92 - $1085.77 | 2 |
| Texas | $1038.47 | $1038.47 | $1015.4 - $1083.03 | 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 55840
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 55840 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 55840
What does CPT code 55840 mean? +
CPT code 55840 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 55840? +
The 2026 Medicare national average non-facility payment for CPT 55840 is $1057.53. Rates range from $964.6 to $1369 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 55840? +
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 55840? +
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 1, 2026.
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