55866
Surgical removal of prostate and surrounding lymph nodes using an endoscope
Our Work > Good Faith Estimates > Surgical Removal of Prostate
Recent regulations require hospitals and health plans to publish prices of a subset of services. The hospital rule requires publication of “shoppable services,” those that can be scheduled in advance by a consumer. The Transparency in Coverage rule requires a list of 500 items and services to be published. Surgical removal of prostate and surrounding lymph nodes using an endoscope appears on both lists, and there is a standard service package available for it.
Prostatectomy is surgery to remove part or all of the prostate gland.It’s most commonly used as a treatment for prostate cancer. Less often, simple prostatectomy may be recommended for men with severe urinary symptoms and very enlarged prostate glands.
Prostatectomy can be performed in several ways, depending on the condition involved. This service package reflects the option of a minimally invasive surgery performed with robotic assistance. Traditional open surgery is rarely used, but would reflect a different set of services and thus a different service package. Additional patient complexity may require more services not represented in the service package. Your service utilization may vary for a number of reasons, including your unique clinical profile and where you receive your services.
This Service Package was generated using outpatient care setting claims. However, this service package may also be performed in the below care settings. Please confirm with your provider in which care setting you will receive services, as this may affect your cost.
- Inpatient: Discuss with your provider
- Outpatient facility: 100%
- Free standing ASC: 0%
Item Definitions
Index
Index
this is the fee for the service being defined; note that other codes may be used to define a similar service
Facility Fee
Facility Fee
these fees are most commonly associated with the index event; these may also be
paid to the facility in addition to the index fee
Professional Fee
Professional Fee
these fees are paid to clinicians for the work associated with this service
Optional Fee
Optional Fee
these services are often also billed with the index event, however may vary based on the patient’s individual circumstances
Ancillary Service
Ancillary Service
these are supply codes that identify other services that may be billed with the index event
Proposed Technical Definition
| association | base_code | code_type | estimated_charge | item_type | name |
|---|---|---|---|---|---|
| 1 | 88323 | CPT | facility_fee | Consultation and report on referred material requiring preparation of slides | |
| 1 | 55866 | CPT | $7,504 | index | Laparoscopic procedures on the prostate |
| 1 | 55866 | CPT | $3,200 | professional_fee | Laparoscopic procedures on the prostate |
| 0.993448702 | 360 | Revenue Code | facility_fee | OR services | |
| 0.957849197 | 636 | Revenue Code | facility_fee | Drugs requiring detailed coding | |
| 865 | CPT | $1,401 | professional_fee | Anesthesia | |
| 0.865327565 | J2405 | HCPCS | 36.7 | facility_fee | Ondansetron hydrochloride injection |
| 0.857478368 | J3010 | HCPCS | 50 | facility_fee | Fentanyl citrate injection |
| 38571 | CPT | $5,480 | facility_fee | Laparoscopic procedures on the lymph Nodes and lymphatic channels | |
| 0.814 | 38571 | CPT | $500 | professional_fee | Laparoscopic procedures on the lymph Nodes and lymphatic channels |
| 0.764585909 | J0690 | HCPCS | 52.38 | facility_fee | Cefazolin sodium injection |
| 0.753461063 | J2704 | HCPCS | 52.3 | facility_fee | Propofol injection |
| 0.752719407 | 80053 | CPT | 519 | facility_fee | Comprehensive metabolic panel (CMP) test |
| 0.735228677 | 51595 | CPT | 13710.43 | facility_fee | Cystectomy |
| 0.713040791 | J1100 | HCPCS | 38.6 | facility_fee | Dexamethasone sodium phosphate injection |
| 0.686 | 88309 | CPT | 700.22 | professional_fee | Level VI surgical pathology, gross, and microscopic examination |
| 0.672126082 | J2250 | HCPCS | 18.66 | facility_fee | Midazolam hydrochloride injection |
| 0.643572311 | 85027 | CPT | 102 | facility_fee | Blood count for CBC, Hgb, Hct, RBC, WBC, and platelet count |
| 0.642 | 865 | CPT | 3137.4 | professional_fee | Anesthesia for extraperitoneal procedures |
| 0.607787392 | J1170 | HCPCS | 27.45 | facility_fee | Hydromorphone injection |
| 0.601854141 | 300 | Revenue Code | facility_fee | Lab services | |
| 0.565 | J3010 | HCPCS | professional_fee | Fentanyl citrate injection | |
| 0.523980222 | J1885 | HCPCS | $40 | facility_fee | Ketorolac tromethamine injection |
| 0.503646477 | 250 | Revenue Code | ancillary_service | Pharmacy | |
| 0.501 | J0690 | HCPCS | professional_fee | Cefazolin sodium injection | |
| 0.494932015 | 305 | Revenue Code | facility_fee | Hematology lab services | |
| 0.484919654 | 301 | Revenue Code | ancillary_service | Chemistry lab services | |
| 0.473733004 | 272 | Revenue Code | ancillary_service | Sterile supplies | |
| 0.470333745 | 710 | Revenue Code | ancillary_service | Recovery Room | |
| 0.437948084 | 370 | Revenue Code | ancillary_service | Anesthesia |
Captured Spending (N=4,000)
| Decile | Base Fee (Facility + Professional) | Base Fee + Optional Fees |
| 1 | 4% | |
| 2 | 0% | |
| 3 | 0% | |
| 4 | 1% | |
| 5 | 2% | |
| 6 | 5% | |
| 7 | 9% | |
| 8 | 12% | |
| 9 | 21% | |
| 10 | 45% |
Our Work > Good Faith Estimates > Surgical Removal of Prostate