CPT 55881
Global 000 ActiveAblt trurl prst8 tis thrm us
CPT 55881 Billing & Documentation Guide
CPT code 55881 (Ablt trurl prst8 tis thrm us) is classified under Surgery (Urinary/Reproductive) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 9.56, a non-facility practice expense RVU of 266.75, and a malpractice RVU of 1.24, a total non-facility RVU of 277.55 and facility RVU of 12.86. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $9659.74, though rates vary from $7994.07 to $13224.41 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 55881, 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 55881 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Endoscopic or minor procedure with related preoperative and postoperative work performed on the same day
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 55881 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 55881
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 9.56 | 9.56 |
| Practice Expense RVU | 266.75 | 2.06 |
| Malpractice RVU | 1.24 | 1.24 |
| Total RVU | 277.55 | 12.86 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 55881
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 | $10895.84 | $434.63 | $10111.96 - $13224.41 | 29 |
| Florida | $9339.33 | $468.97 | $8899.23 - $9699.04 | 3 |
| Georgia | $8869.2 | $434.99 | $8316.13 - $9422.26 | 2 |
| Illinois | $9008.57 | $466.06 | $8518.59 - $9545.19 | 4 |
| Michigan | $8743.81 | $442.22 | $8500.62 - $8986.99 | 2 |
| North Carolina | $8658.52 | $409.97 | $8658.52 - $8658.52 | 1 |
| New York | $10330.41 | $467.52 | $8812.63 - $11010.28 | 5 |
| Ohio | $8495.61 | $423.88 | $8495.61 - $8495.61 | 1 |
| Pennsylvania | $9093.51 | $433.86 | $8537.55 - $9649.46 | 2 |
| Texas | $9131.13 | $427.28 | $8465.61 - $9783.1 | 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 55881
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 55881 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 00910 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 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 |
| 0739T | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 12001 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 12002 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 12004 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 12005 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 12006 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 12007 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 55881
What does CPT code 55881 mean? +
CPT code 55881 represents: Ablt trurl prst8 tis thrm us. It's in the Surgery (Urinary/Reproductive) category with a global period of 000.
What is the Medicare reimbursement for CPT 55881? +
The 2026 Medicare national average non-facility payment for CPT 55881 is $9659.74. Rates range from $7994.07 to $13224.41 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 55881? +
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 55881? +
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 April 17, 2026.
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