Summary & Overview
CPT 55842: Radical Prostatectomy with Pelvic Lymph Node Removal
CPT code 55842 represents a radical prostatectomy procedure that removes the prostate gland and adjacent tissues, including sampling or removal of pelvic lymph nodes, with the option of nerve-sparing based on surgical judgment. This procedure is a central intervention in the management of clinically significant prostate disease and has national relevance for surgical oncology, postoperative care pathways, and payer coverage policies due to its cost, potential complications, and implications for functional outcomes.
Key payers in the national landscape include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and typical sites of service, plus benchmarks and policy-relevant considerations where available. The publication summarizes utilization benchmarks, common billing modifiers and coding considerations, and intersections with care management and postoperative quality measures. It also highlights payer coverage patterns and documentation expectations that commonly affect claims processing and prior authorization workflows.
This summary is intended for clinicians, coding professionals, and policy analysts seeking a focused, national-level briefing on how CPT code 55842 is used in practice, how it aligns with surgical service lines, and what payer groups commonly process claims for this service. Data not available in the input is noted where appropriate elsewhere in the publication.
Billing Code Overview
CPT code 55842 describes a surgical procedure in which the provider removes the prostate gland and some surrounding tissues, including removal of some pelvic lymph nodes. The description indicates the surgeon may or may not spare the nerve supply during the operation.
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Service type: Surgical prostatectomy with pelvic lymph node removal
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Typical site of service: Hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 66-year-old male with clinically localized prostate cancer is evaluated for definitive surgical treatment. After prostate biopsy confirmed adenocarcinoma and staging studies (pelvic MRI and bone scan) show disease confined to the prostate with possible focal extracapsular extension, the urologic oncology team schedules a radical prostatectomy with pelvic lymph node dissection. The patient undergoes general anesthesia in an inpatient operating room setting. The surgeon performs removal of the prostate gland and some surrounding tissue; a bilateral pelvic lymphadenectomy is performed. The operative approach may be open retropubic, laparoscopic, or robot-assisted; the surgeon documents whether a nerve-sparing technique is attempted. Typical perioperative workflow includes preoperative evaluation by anesthesia, intraoperative pathology or frozen section if indicated, placement of a urinary catheter postoperatively, and inpatient monitoring for 1–3 days with discharge instructions and pathology follow-up to guide adjuvant therapy decisions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard reporting | Use for routine reporting when no modifier applies |
11 | Professional component |