2025 CPT code 55831
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgical Procedures on the Male Genital System - Excision Procedures on the Prostate Surgery Feed
Subtotal retropubic prostatectomy, including management of postoperative bleeding, vasectomy, meatotomy, urethral calibration/dilation, and internal urethrotomy.
Modifiers may be applicable depending on the circumstances of the procedure, including but not limited to: 51 (multiple procedures), 58 (staged procedures), 62 (two surgeons), 78 (unplanned return to OR), and others.
Medical necessity for a subtotal retropubic prostatectomy is established by significant urinary symptoms (e.g., urinary retention, frequency, urgency, nocturia) caused by prostatic enlargement or tumor, unresponsive to less invasive treatments.The procedure must be deemed appropriate and necessary by the physician after considering the patient's overall health and the risks and benefits of surgery.
The surgeon is responsible for all aspects of the procedure, including preoperative planning, intraoperative technique, and postoperative care.This includes managing bleeding, potential complications, and ensuring proper urinary function post-surgery.
- Surgery
- Surgical Procedures on the Male Genital System > Surgical Procedures on the Prostate > Excision Procedures on the Prostate
In simple words: The surgeon removes part of the prostate gland through a cut below the pubic bone. This may include cutting and widening the urethra (the tube that carries urine) to improve urine flow.The procedure is done to treat an enlarged or cancerous prostate that is blocking urine flow.
This procedure involves the surgical removal of a portion of the prostate gland through a retropubic incision.It includes control of postoperative bleeding, vasectomy (if necessary), meatotomy (incision of the urinary opening), urethral calibration or dilation, and internal urethrotomy (incision of the urethra). The procedure is indicated for the treatment of prostatic enlargement or tumors obstructing urinary flow.The extent of the prostatectomy is subtotal, meaning less than the complete removal of the prostate gland.
Example 1: A 65-year-old male presents with significant urinary symptoms due to benign prostatic hyperplasia (BPH).A subtotal retropubic prostatectomy (55831) is performed to relieve urinary obstruction., A 72-year-old male is diagnosed with a small, localized prostate tumor. A subtotal retropubic prostatectomy (55831) is performed to remove the tumor and improve urinary function., A 78-year-old male undergoes a retropubic prostatectomy (55831) for BPH.During the procedure, the urethra requires dilation, and a small portion of the vas deferens is removed.
* Complete history and physical examination focusing on urinary symptoms and prostate examination findings.* Preoperative imaging (e.g., transrectal ultrasound) to assess prostate size and location of any tumors.* Operative report detailing the procedure, including the approach (retropubic), extent of prostate resection, and any additional procedures (e.g., meatotomy, urethral dilation).* Pathology report confirming the diagnosis and any presence of malignancy.* Postoperative progress notes documenting the patient's recovery, including urinary output, complications (if any), and length of hospital stay.
** Always verify payer specific guidelines and policies before billing.Accurate documentation and coding are crucial for successful claim processing and reimbursement.
- Revenue Code: 272, 279 (for hospital use of devices)
- RVU: The RVUs vary based on the year and payer.Check the current Medicare Physician Fee Schedule for the most up-to-date values.There are no current Medicare valuations for these procedures performed in the physician office setting.
- Global Days : 90-day global period
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier is not usually applicable to 55831, as it encompasses the entire procedure.
- Fee Schedule : Fee schedules vary by payer and year. Refer to historical payer fee schedules for specific information.
- Specialties:Urology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center