CPT 55812: Radical Perineal Prostatectomy for Prostate Cancer - OpenPayer

Summary & Overview

CPT 55812: Radical Perineal Prostatectomy for Prostate Cancer

CPT code 55812 represents a radical perineal prostatectomy — a surgical procedure to remove the prostate via a perineal incision, including excision of nearby tissues and regional lymph nodes for pathological evaluation. This code captures definitive surgical management for localized prostate cancer and is relevant nationally due to prostate cancer incidence, surgical practice patterns, and implications for perioperative care and cancer staging. Key payers in national analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical intent and typical sites of service, payer coverage context, and the common modifiers associated with this service. The publication also summarizes benchmarks related to utilization and reimbursement structures where available, highlights policy considerations affecting access to surgical oncology services, and provides clinical context for coding and documentation, including the role of lymph node removal and submission for pathology. Data not available in the input is noted where relevant; the focus is on describing the procedure, expected service setting, and the payer landscape affecting national practice and billing for this surgical oncology code.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare55812CPTprostatectomyprostate cancersurgical oncologyoperating roomambulatory surgeryradical perineal prostatectomy

Billing Code Overview

CPT code 55812 describes a radical perineal prostatectomy performed to treat prostate cancer. The procedure involves excision of the prostate gland through an incision in the perineum, removal of surrounding tissues to achieve oncologic clearance, and excision of regional lymph nodes with submission of those nodes to a laboratory for pathological analysis.

Service type: Surgical prostatectomy for oncologic resection
Typical site of service: Hospital operating room or ambulatory surgery center

Clinical & Coding Specifications

Clinical Context

A 68-year-old male with biopsy-proven, clinically localized prostate adenocarcinoma elects for definitive surgical management. Preoperative staging including multiparametric MRI and pelvic lymph node imaging suggests organ-confined disease with possible regional nodal involvement. The patient undergoes a radical perineal prostatectomy (CPT 55812) performed under general anesthesia via a perineal incision. The surgical team excises the prostate gland, seminal vesicles as indicated, and performs selective pelvic lymph node dissection with specimens submitted to pathology for histologic staging. Typical perioperative workflow includes preoperative assessment and optimization by anesthesia, informed consent documenting cancer treatment intent, intraoperative specimen collection and labeling, immediate postoperative recovery in the PACU, pain control and DVT prophylaxis, and coordination of pathology results to guide adjuvant therapy decisions. Typical site of service is an inpatient hospital operating room or an ambulatory surgery center when clinically appropriate.

Coding Specifications

Modifier	Description	When to Use
`00`	Global or default policy (not a standard CMS modifier; retained per input list)	Use only if payer-specific guidance requires a code representing default billing status — verify payer policy.

CPT 55801: Perineal Prostatectomy for Obstructive Prostate Disease

cpt-55810-perineal-prostatectomy-for-prostate-cancer

CPT 55810: Perineal Prostatectomy for Prostate Cancer

cpt-55840-radical-retropubic-prostatectomy

CPT 55840: Radical Retropubic Prostatectomy

cpt-55831-open-prostatectomy-lower-abdominal-approach

CPT 55831: Open Prostatectomy via Lower Abdominal Approach

cpt-55821-open-prostatectomy-lower-abdominal-approach

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

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

CPT 55865: Perineal Prostate Incision with Lymph Node Sampling

cpt-55860-perineal-access-for-prostate-brachytherapy

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-55845-radical-prostatectomy-with-pelvic-lymph-node-dissection

CPT 55845: Radical Prostatectomy with Pelvic Lymph Node Dissection

cpt-55815-perineal-prostatectomy-with-lymph-node-dissection

CPT 55815: Perineal Prostatectomy with Lymph Node Dissection

Showing 1–10 of 11

Taxonomy Code	Specialty	Notes
`208100000X`	Urology	Primary specialty performing radical prostatectomy procedures.
`207P00000X`	Physician/Surgeon - General Surgery	May be involved in complex pelvic surgery or multi-specialty cases.
`208800000X`	Surgical Oncology	In centers where oncologic surgeons participate in prostate cancer resections and nodal dissection.
`364S00000X`	Pathology	Responsible for processing and interpreting prostate and lymph node specimens (professional component of pathology).

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.	Data not available in the input.	Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`55866`	Laparoscopy, surgical prostatectomy, retropubic radical, including nerve-sparing when performed	Alternative surgical approach (retropubic) to definitive prostate removal; may be chosen instead of perineal approach based on anatomy and oncologic factors.
`55845`	Transurethral resection of the prostate (TURP), including control of postoperative bleeding	May be performed preoperatively for urinary obstruction or postoperatively to manage obstructive complications.
`38571`	Biopsy or excision of lymph node(s); open, superficial	Used for diagnostic or limited nodal sampling when separate from the formal pelvic lymph node dissection specimen.
`38572`	Biopsy or excision of lymph node(s); open, deep (e.g., deep axillary, inguinal, pelvic)	Relevant for pelvic lymph node excision performed during radical prostatectomy when reported separately.
`88305`	Surgical pathology, gross and microscopic examination, Level IV	Common pathology CPT code for processing and microscopic examination of prostate and lymph node specimens submitted after prostatectomy.
`99223`	Initial hospital care, typically 70 minutes or more	Typical initial inpatient hospital care code for complex postoperative management following major surgery like radical prostatectomy when billed separately by the admitting/provider team.

OpenPayer