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CPT 55700: Prostate Incision or Operative Procedure
CPT code 55700 — deleted December 31, 2025 — historically denoted a prostate surgical procedure involving incision or operative management. Its deletion has national relevance because it affects coding practices for prostate interventions, claim adjudication workflows, and crosswalk efforts to alternative codes. The change influences billing for procedures performed in hospitals and ambulatory surgical centers where prostate operations occur.
This analysis covers major national payers: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise account of the code's status, implications for billing and coding workflows, and connections to related procedural coding (for example, codes addressing incision procedures on the prostate). The publication summarizes clinical context for prostate procedures, typical diagnostic scenarios that prompted use of the code, and operational considerations for replacing a deleted code, such as selecting current valid CPT codes and reviewing payer-specific billing policies.
The content provides benchmarks and policy update context at a national level, highlights where to look for alternative coding pathways, and outlines the clinical settings where affected services are performed. Data not available in the input are noted where applicable.
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Billing Code Overview
CPT code 55700 is listed as deleted effective December 31, 2025. The code previously represented a prostate-related surgical procedure; based on that description, the service type is a prostate incision or operative prostate procedure. The typical site of service for this procedure is an inpatient or ambulatory surgical setting, including hospital operating rooms and ambulatory surgery centers.
Data not available in the input for additional operational details.
National Reimbursement Benchmarks
National commercial rates for CPT 55700 center near the BUCA average commercial rate of $517, with notable variation across major insurers. Blue Cross Blue Shield shows the highest dispersion between its 75th and 25th percentiles (P75 $790.40 minus P25 $472.40 = $318.00), indicating wider negotiated spreads, while Aetna and UnitedHealth Group exhibit tighter interquartile ranges of $162.20 (Aetna P75 $444.30 minus P25 $228.10) and $220.00 (UnitedHealth Group P75 $439.50 minus P25 $217.50), respectively. Cigna’s IQR is $317.40 (P75 $609.40 minus P25 $294.00), similar to Blue Cross Blue Shield.
Price dispersion suggests that payers such as Blue Cross Blue Shield and Cigna allow larger upside above their lower quartile rates, whereas Aetna presents a more compressed commercial range around its median. UnitedHealth Group falls between these extremes. BUCA’s mean of $517 provides a mid-market reference point for commercial arrangements across the listed carriers.