Summary & Overview
CPT 55720: Incision and Drainage of Prostatic Abscess
CPT code 55720 represents incision and drainage of a prostatic abscess, a focused urologic surgical procedure to evacuate purulent material from the prostate caused by bacterial infection. This code captures an urgent operative intervention that can be clinically necessary to control sepsis, relieve obstructive symptoms, and prevent progression of infection. Nationally, proper use and documentation of this code affect hospital and surgical utilization metrics and contribute to quality and safety reporting in acute urologic care.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines payer coverage patterns and coding benchmarks where available and highlights clinical context for correct procedure identification.
Readers will learn the clinical scope and typical sites of service for 55720, an overview of common billing modifiers associated with operative procedures (listed in the input), and where to find related coding considerations. The report also provides benchmarking and policy context when available and notes areas where input data were not supplied. This material is intended for coding professionals, billing compliance staff, and clinical leaders seeking clarity on the use of CPT code 55720 in acute prostatic infection management.
Billing Code Overview
CPT code 55720 describes a surgical procedure in which the provider incises the prostate gland to drain an abscess resulting from bacterial infection. This procedure is an intraoperative urologic drainage intervention intended to evacuate purulent material and relieve acute prostatic sepsis.
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Service type: Surgical, operative drainage of the prostate (incision and drainage)
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Typical site of service: Hospital operating room or procedure suite, and may also be performed in an inpatient or ambulatory surgical center setting depending on clinical acuity and patient status.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is a male aged 40–80 presenting with acute urinary symptoms, fever, perineal or pelvic pain, and urinary retention. Evaluation includes history, physical exam with digital rectal exam demonstrating a tender, fluctuant prostate, urinalysis showing pyuria, and urine/blood cultures. Imaging (transrectal ultrasound or pelvic CT) confirms a prostatic abscess. Initial management includes IV antibiotics, analgesia, and bladder drainage as needed. When imaging and clinical course indicate a discrete abscess that is not resolving with medical therapy or when there is sepsis or significant urinary retention, the urologist performs transurethral or transrectal incision and drainage of the prostate (CPT 55720) in an operating room or procedure suite under regional or general anesthesia. Post-procedure care includes monitoring for bleeding, urinary drainage with catheterization, continuation of targeted antibiotics, and follow-up imaging or ultrasound-guided reassessment if symptoms persist.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work or complexity of 55720 is substantially greater than typical due to severe infection, extensive debridement, or unexpected intraoperative findings. |