Find policies, billing codes, payers, states, and providers

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.

Customize your policy alerts

Sign up for cpt 55801 policy alerts

Get alerted when payer policies referencing 55801 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

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.

Find policies, billing codes, payers, states, and providers

CPT 55801: Perineal Prostatectomy for Obstructive Prostate Disease

Customize your policy alerts

Sign up for cpt 55801 policy alerts

Get alerted when payer policies referencing 55801 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Billing Code Overview

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.
`11`	Office or other outpatient visit (distinct procedural modifier)	Not typically appended to `55801`; included when payer-specific requirements denote primary procedure reporting.
`22`	Increased procedural services	Use when the work, time, and intensity of `55801` substantially exceed typical; documentation must support.
`23`	Unusual anesthesia — medically necessary	Use when procedure performed without standard anesthesia due to medical reasons; documentation required.
`26`	Professional component	Use only if billing professional component separately from facility for a service that has distinct professional component (rare for `55801`).
`52`	Reduced service	Use when a patient or clinical circumstance results in a substantially reduced service compared with full `55801`.
`53`	Discontinued procedure	Use when `55801` is started but discontinued for patient-related or surgical reasons prior to completion.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of `55801`.
`66`	Surgical team	Use when a surgical team approach is required for `55801` and team reporting is permitted by payer.
`78`	Unplanned return to the operating room following initial procedure	Use when the patient returns to OR for complications related to `55801` during the global period.
`80`	Assistant surgeon	Use when an assistant surgeon performs a defined role during `55801` and assistant fees are billed.
`81`	Minimum assistant surgeon	Use when a minimal assistant service is performed during `55801` per payer rules.
`82`	Assistant surgeon (when qualified resident not available)	Use when an assistant surgeon is necessary and no qualified resident is available for `55801`.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist service	Use when these non-physician practitioners perform portions of care associated with `55801` per payer policies.

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`.

CPT 55810: Perineal Prostatectomy for Prostate Cancer

CPT-55812-RADICAL-PERINEAL-PROSTATECTOMY

CPT 55812: Radical Perineal Prostatectomy for Prostate Cancer

CPT-55815-PERINEAL-PROSTATECTOMY-WITH-LYMPH-NODE-DISSECTION

CPT 55815: Perineal Prostatectomy with Lymph Node Dissection

CPT-55821-OPEN-PROSTATECTOMY-LOWER-ABDOMINAL-APPROACH

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

CPT-55831-OPEN-PROSTATECTOMY-LOWER-ABDOMINAL-APPROACH

CPT 55831: Open Prostatectomy via Lower Abdominal Approach

CPT-55840-RADICAL-RETROPUBIC-PROSTATECTOMY

CPT 55840: Radical Retropubic Prostatectomy

CPT-55842-RADICAL-PROSTATECTOMY-WITH-PELVIC-LYMPH-NODE-REMOVAL

CPT 55842: Radical Prostatectomy with Pelvic Lymph Node Removal

CPT-55845-RADICAL-PROSTATECTOMY-WITH-PELVIC-LYMPH-NODE-DISSECTION

CPT 55845: Radical Prostatectomy with Pelvic Lymph Node Dissection

CPT-55860-PERINEAL-ACCESS-FOR-PROSTATE-BRACHYTHERAPY

CPT 55860: Perineal Access for Prostate Brachytherapy

CPT-55862-PROSTATE-PERINEAL-ACCESS-BRACHYTHERAPY-LYMPH-NODE-SAMPLING

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

Showing 1–10 of 11

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

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.
`11`	Office or other outpatient visit (distinct procedural modifier)	Not typically appended to `55801`; included when payer-specific requirements denote primary procedure reporting.
`22`	Increased procedural services	Use when the work, time, and intensity of `55801` substantially exceed typical; documentation must support.
`23`	Unusual anesthesia — medically necessary	Use when procedure performed without standard anesthesia due to medical reasons; documentation required.
`26`	Professional component	Use only if billing professional component separately from facility for a service that has distinct professional component (rare for `55801`).
`52`	Reduced service	Use when a patient or clinical circumstance results in a substantially reduced service compared with full `55801`.
`53`	Discontinued procedure	Use when `55801` is started but discontinued for patient-related or surgical reasons prior to completion.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of `55801`.
`66`	Surgical team	Use when a surgical team approach is required for `55801` and team reporting is permitted by payer.
`78`	Unplanned return to the operating room following initial procedure	Use when the patient returns to OR for complications related to `55801` during the global period.
`80`	Assistant surgeon	Use when an assistant surgeon performs a defined role during `55801` and assistant fees are billed.
`81`	Minimum assistant surgeon	Use when a minimal assistant service is performed during `55801` per payer rules.
`82`	Assistant surgeon (when qualified resident not available)	Use when an assistant surgeon is necessary and no qualified resident is available for `55801`.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist service	Use when these non-physician practitioners perform portions of care associated with `55801` per payer policies.

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`.

CPT 55810: Perineal Prostatectomy for Prostate Cancer

CPT-55812-RADICAL-PERINEAL-PROSTATECTOMY

CPT 55812: Radical Perineal Prostatectomy for Prostate Cancer

CPT-55815-PERINEAL-PROSTATECTOMY-WITH-LYMPH-NODE-DISSECTION

CPT 55815: Perineal Prostatectomy with Lymph Node Dissection

CPT-55821-OPEN-PROSTATECTOMY-LOWER-ABDOMINAL-APPROACH

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

CPT-55831-OPEN-PROSTATECTOMY-LOWER-ABDOMINAL-APPROACH

CPT 55831: Open Prostatectomy via Lower Abdominal Approach

CPT-55840-RADICAL-RETROPUBIC-PROSTATECTOMY

CPT 55840: Radical Retropubic Prostatectomy

CPT-55842-RADICAL-PROSTATECTOMY-WITH-PELVIC-LYMPH-NODE-REMOVAL

CPT 55842: Radical Prostatectomy with Pelvic Lymph Node Removal

CPT-55845-RADICAL-PROSTATECTOMY-WITH-PELVIC-LYMPH-NODE-DISSECTION

CPT 55845: Radical Prostatectomy with Pelvic Lymph Node Dissection

CPT-55860-PERINEAL-ACCESS-FOR-PROSTATE-BRACHYTHERAPY

CPT 55860: Perineal Access for Prostate Brachytherapy

CPT-55862-PROSTATE-PERINEAL-ACCESS-BRACHYTHERAPY-LYMPH-NODE-SAMPLING

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

Showing 1–10 of 11

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 55801: Perineal Prostatectomy for Obstructive Prostate Disease

Sign up for cpt 55801 policy alerts

Billing Code Overview

Catch payer policy changes before they impact reimbursement

Catch payer policy changes before they impact reimbursement

OpenPayer

CPT 55801: Perineal Prostatectomy for Obstructive Prostate Disease

Sign up for cpt 55801 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

CPT 55801: Perineal Prostatectomy for Obstructive Prostate Disease

Sign up for cpt 55801 policy alerts

Billing Code Overview

CPT 55801: Perineal Prostatectomy for Obstructive Prostate Disease

Sign up for cpt 55801 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What clinical scenario and procedure does CPT 55801 cover?

Where is CPT 55801 normally performed and what is the expected postoperative disposition?

Which provider specialties and taxonomy codes are associated with billing for 55801?

What modifiers are commonly referenced for CPT 55801 and when might they apply?

What related CPT codes should be considered when billing or reviewing care involving CPT 55801?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What clinical scenario and procedure does CPT 55801 cover?

Where is CPT 55801 normally performed and what is the expected postoperative disposition?

Which provider specialties and taxonomy codes are associated with billing for 55801?

What modifiers are commonly referenced for CPT 55801 and when might they apply?

What related CPT codes should be considered when billing or reviewing care involving CPT 55801?

References