Summary & Overview
CPT 55840: Radical Retropubic Prostatectomy
CPT code 55840 denotes a radical retropubic prostatectomy in which the surgeon removes the entire prostate and adjacent tissues via a retropubic approach; nerve-sparing may be performed when appropriate. This procedure is a central surgical option for localized prostate cancer and certain other prostatic conditions, with national significance due to its impact on oncologic outcomes, functional recovery, and surgical resource use.
Key payers considered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical intent and typical settings for the service, alongside expected payer coverage patterns and commonly used modifiers where available. The publication summarizes national benchmarks for utilization and payment, highlights recent policy and coding guidance relevant to radical prostatectomy, and provides clinical context about indications and care setting choices.
This summary is designed for health plan analysts, coding specialists, and clinical leaders seeking a clear, national-level snapshot of CPT code 55840, including what the code represents, how it is used across payers, and which operational and policy considerations commonly affect billing and coverage.
Billing Code Overview
CPT code 55840 describes a surgical procedure in which the provider removes all of the prostate and some surrounding structures using a retropubic approach; the nerve supply may or may not be spared. This represents a radical retropubic prostatectomy, categorized as a major urologic operative service.
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Service type: Major surgical excision of the prostate (radical prostatectomy)
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Typical site of service: Hospital operating room or ambulatory surgical center (inpatient or outpatient surgical setting depending on clinical indications and post-operative needs)
Clinical & Coding Specifications
Clinical Context
A typical patient is a 65-year-old man with clinically localized prostate cancer confirmed by prostate biopsy and staging studies who is scheduled for a retropubic radical prostatectomy. The patient presents preoperatively with urinary hesitancy, elevated prostate-specific antigen (PSA), and imaging consistent with organ-confined disease. The clinical workflow includes preoperative counseling, anesthesia evaluation, informed consent addressing possible nerve-sparing versus non–nerve-sparing technique, and perioperative planning for catheterization and analgesia. In the operating room the urologic surgeon performs an open retropubic approach to remove the entire prostate gland and some surrounding periprostatic tissue; dependent on oncologic and functional considerations the surgeon may attempt unilateral or bilateral nerve-sparing. Postoperatively the patient is monitored for bleeding, urinary drainage via Foley catheter, pain control, deep vein thrombosis prophylaxis, and instructions for catheter care and follow-up PSA monitoring and pathology review.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier used / default | General billing when no other modifier applies |
11 | Professional component |