CPT 55801: Perineal Prostatectomy for Obstructive Prostate Disease - OpenPayer

Summary & Overview

CPT 55801: Perineal Prostatectomy for Obstructive Prostate Disease

CPT code 55801 denotes a perineal prostatectomy: surgical excision of the prostate through a perineal incision, often including removal of the vas deferens and urethral adjustment to relieve obstruction from tumor or benign enlargement. Nationally, this code represents a significant urologic surgical intervention for obstructive lower urinary tract conditions and prostate malignancy when the perineal approach is clinically indicated. It is relevant to hospitals, surgical practices, and payers managing complex urologic surgical episodes.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and common billing considerations tied to this invasive urologic surgery. The publication also presents benchmarks and payer coverage patterns where available, highlights coding nuances for the perineal approach versus other prostatectomy techniques, and summarizes policy and reimbursement issues that commonly affect claims for major prostate surgery.

This executive summary equips clinicians, billing professionals, and policy stakeholders with the clinical framing and payer universe for 55801, plus pointers to deeper sections on billing practice, coverage variability, and coding alignment with surgical documentation. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare55801CPTprostatectomyurologysurgical-proceduresperineal-approachoperating-roominpatient-surgery

Billing Code Overview

CPT code 55801 describes a surgical procedure in which the provider performs a perineal prostatectomy: excision of the prostate gland through an incision in the perineum. The description includes removal of the vas deferens and enlargement or incision of the urethra as needed, with hemostatic measures taken to control bleeding. This procedure is typically performed to treat a prostate tumor or persistent prostatic enlargement that obstructs urinary flow.

Service type: Surgical prostatectomy (perineal approach)
Typical site of service: Operating room or inpatient surgical suite, often resulting in an inpatient stay given the invasive nature of the procedure.

Clinical & Coding Specifications

Clinical Context

A 68-year-old male presents with progressive lower urinary tract symptoms, recurrent urinary retention, and hematuria. Digital rectal exam and prostate-specific antigen testing raise concern for malignancy or significant benign prostatic hyperplasia causing obstruction. Imaging and biopsy confirm a prostate tumor or a large obstructing prostate. The urologist schedules a radical perineal prostatectomy (55801) performed under general or regional anesthesia in an operating room or ambulatory surgical center configured for major urologic surgery. The procedure involves a perineal incision to excise the prostate gland and seminal vesicles as indicated, ligation of the vas deferens, urethral incision and reconstruction, hemostasis, and placement of urinary drainage (catheter). Typical perioperative workflow includes preoperative evaluation, anesthesia consent, intraoperative urethral catheter placement, specimen sent to pathology, and postoperative monitoring with pain control and urinary catheter management. Recovery may occur in a PACU with inpatient admission if complications or significant comorbidity require observation. Follow-up includes wound checks, catheter removal timeline, and pathology review guiding further oncology care if cancer is confirmed.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier specified (placeholder)	Rarely used; reserved in some payer systems as a default when no special modifier applies.

CPT 55815: Perineal Prostatectomy with Lymph Node Dissection

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CPT 55845: Radical Prostatectomy with Pelvic Lymph Node Dissection

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CPT 55862: Perineal Prostate Access for Brachytherapy with Lymph Node Sampling

cpt-55812-radical-perineal-prostatectomy

CPT 55812: Radical Perineal Prostatectomy for Prostate Cancer

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CPT 55860: Perineal Access for Prostate Brachytherapy

cpt-55842-radical-prostatectomy-with-pelvic-lymph-node-removal

CPT 55842: Radical Prostatectomy with Pelvic Lymph Node Removal

cpt-55865-perineal-prostate-incision-lymph-node-sampling-brachytherapy-access

CPT 55865: Perineal Prostate Incision with Lymph Node Sampling

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CPT 55810: Perineal Prostatectomy for Prostate Cancer

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CPT 55840: Radical Retropubic Prostatectomy

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CPT 55821: Open Prostatectomy via Lower Abdominal (Suprapubic) Approach

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Taxonomy Code	Specialty	Notes
`208800000X`	Urology	Primary specialty performing `55801`.
`2080P0206X`	Surgical Oncology	Utilized when prostate cancer management is coordinated with surgical oncologist.
`207R00000X`	General Surgery	May assist or provide care in centers where general surgeons participate in complex pelvic surgery.
`208D00000X`	Pediatrics (Urology)	Included for completeness if pediatric urologic reconstruction were relevant (rare for `55801`).
`363L00000X`	Anesthesiology	Provides perioperative anesthesia services for `55801`.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C61`	Malignant neoplasm of prostate	Primary oncologic indication for radical prostatectomy (`55801`) when tumor is localized and patient is a surgical candidate.
`N40.1`	Benign prostatic hyperplasia with lower urinary tract symptoms	Non-malignant prostatic enlargement causing obstruction; large obstructing glands may require surgical removal.
`R33.9`	Retention of urine, unspecified	Acute or chronic urinary retention due to prostate obstruction can lead to definitive surgical management with `55801`.
`R31.9`	Hematuria, unspecified	Gross or recurrent hematuria from prostate pathology may prompt evaluation and surgical treatment.
`Z85.46`	Personal history of malignant neoplasm of prostate	Relevant for surveillance and decision-making about additional oncologic surgery or management.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`55840`	Radical retropubic prostatectomy, with or without pelvic lymphadenectomy	Alternative surgical approach to prostate removal via abdominal incision; chosen based on tumor location, surgeon preference, or need for pelvic lymph node dissection.
`38571`	Biopsy or excision of lymph node(s); open, deep axillary or inguinal (separate code for pelvic nodes not exact)	Pelvic lymph node excision or sampling is often performed with prostatectomy when cancer staging is required; coding uses appropriate pelvic lymph node codes.
`55700`	Biopsy, prostate; needle or punch, single or multiple, any approach	Diagnostic prostate biopsy commonly precedes `55801` to confirm malignancy.
`51701`	Measurement of post-void residual urine and/or uroflowmetry	Preoperative urodynamic testing to evaluate bladder function in patients with obstructive symptoms prior to definitive prostatectomy.
`51703`	Urodynamic testing, complex studies	Advanced urodynamics may be performed preoperatively to assess bladder outlet obstruction and detrusor function.
`54050`	Urethral repair, simple; primary repair of urethra	Urethral reconstruction or repair codes may be used when additional urethral procedures are required during or after `55801`.

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