CPT 55845: Radical Prostatectomy with Pelvic Lymph Node Dissection - OpenPayer

Summary & Overview

CPT 55845: Radical Prostatectomy with Pelvic Lymph Node Dissection

CPT code 55845 represents a radical prostatectomy with removal of the prostate and surrounding tissues, including bilateral pelvic lymph node dissection of the external iliac, hypogastric, and obturator nodes. This procedure is a central component of definitive surgical management for clinically localized and some locally advanced prostate cancer and carries implications for surgical oncology capacity, perioperative care, and post-operative surveillance nationally. Coverage and payment policies for this code affect hospital and ambulatory surgery center workflows, resource allocation, and patient access to definitive therapy.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical service represented by the code, typical sites of service, commonly reported modifiers, and what to expect in payer review and billing practice. The publication summarizes benchmarks and policy-relevant points, clarifies clinical context for coding accuracy, and highlights areas where payers commonly apply medical necessity and documentation standards. Data not available in the input for payer-specific rates and utilization metrics is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare55845CPTradical prostatectomypelvic lymph node dissectionurologysurgical oncologyoperating roomambulatory surgery

Billing Code Overview

CPT code 55845 describes a surgical procedure in which the provider removes the prostate and surrounding tissues, including the external iliac, hypogastric, and obturator lymph nodes. The description notes that the surgeon "may or may not spare the nerve supply," indicating the procedure can be performed with or without nerve-sparing technique.

Service type: Radical prostatectomy with bilateral pelvic lymph node dissection
Typical site of service: Hospital operating room or ambulatory surgery center, depending on clinical complexity and patient condition

Data not available in the input for payer-specific coverage, associated taxonomies, ICD-10 diagnoses, and related billing lines.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 65-year-old male with biopsy-proven localized prostate adenocarcinoma, rising prostate-specific antigen (PSA), and imaging that suggests organ-confined disease or limited regional nodal involvement. The patient presents for definitive surgical management: radical prostatectomy with pelvic lymph node dissection. Preoperative workflow includes urology consultation, informed consent addressing nerve-sparing options, anesthesia evaluation, pre-op labs, and cross-sectional imaging (CT or MRI) to assess lymph nodes. Intraoperatively, the surgeon performs removal of the prostate and seminal vesicles and dissects the external iliac, hypogastric (internal iliac), and obturator lymph nodes; a nerve-sparing approach may be performed depending on tumor location and oncologic considerations. Postoperative care includes recovery from anesthesia, monitoring for bleeding, urinary catheter management, pain control, pathology review of the prostate and lymph nodes, and discharge planning with follow-up for oncologic management and functional recovery.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — standard reporting	Use when no additional modifier applies and the full service is reported as usual.
`11`

CPT 55865: Perineal Prostate Incision with Lymph Node Sampling

cpt-55801-perineal-prostatectomy-for-obstructive-prostate-disease

CPT 55801: Perineal Prostatectomy for Obstructive Prostate Disease

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CPT 55812: Radical Perineal Prostatectomy for Prostate Cancer

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

CPT 55842: Radical Prostatectomy with Pelvic Lymph Node Removal

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

CPT 55815: Perineal Prostatectomy with Lymph Node Dissection

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

CPT 55831: Open Prostatectomy via Lower Abdominal Approach

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

CPT 55810: Perineal Prostatectomy for Prostate Cancer

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CPT 55860: Perineal Access for Prostate Brachytherapy

cpt-55840-radical-retropubic-prostatectomy

CPT 55840: Radical Retropubic Prostatectomy

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

Showing 1–10 of 11

Taxonomy Code	Specialty	Notes
2084P0800X	Urology	Primary specialty performing radical prostatectomy and pelvic lymph node dissection.
207RH0000X	General Surgery	General surgeons with oncologic focus may perform pelvic oncologic procedures in some systems.
207T00000X	Surgical Oncology	Surgical oncologists performing complex pelvic cancer resections.
208VP0000X	Urologic Oncology	Subspecialty within urology focused on genitourinary cancers and advanced prostate surgery.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C61`	Malignant neoplasm of prostate	Primary indication for radical prostatectomy with pelvic lymph node dissection.
`N40`	Benign prostatic hyperplasia	May coexist; generally not the indication for complete prostate removal with lymphadenectomy but relevant to symptoms and operative planning.
`D40.0`	Neoplasm of uncertain behavior of prostate	May prompt diagnostic or definitive surgery depending on pathology and clinical judgment.
`R97.20`	Elevated prostate specific antigen (PSA), unspecified	Common clinical finding prompting biopsy and definitive treatment such as prostatectomy.
`C79.5`	Secondary malignant neoplasm of bone	Relevant for staging; presence of distant metastasis may change surgical candidacy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`55866`	Laparoscopic radical prostatectomy (simple/other approach)	Alternative minimally invasive approach; may be performed instead of open `55845` depending on surgeon technique.
`38571`	Biopsy or excision of lymph node(s); open, superficial	Performed for isolated nodal sampling when limited nodes are removed separately from radical prostatectomy specimen.
`43235`	Laparoscopy, surgical, gastric or abdominal procedures (example for access)	Represents laparoscopic access codes that may be used in minimally invasive approaches; adjunct to robotic/laparoscopic prostatectomy.
`55866`	Robotic-assisted prostatectomy (if documented as approach)	Robotic-assisted techniques often billed with the appropriate radical prostatectomy code and robotic supply/assistant modifiers per payer policy.

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