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

Summary & Overview

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

CPT code 55862 denotes a surgical perineal approach to the prostate used to facilitate placement of radioactive material (brachytherapy) for malignant prostate cancer and includes sampling of regional lymph nodes with tissue sent for laboratory analysis. This procedure is a component of definitive local therapy for prostate malignancy and is relevant for surgical oncology, radiation oncology coordination, and pathology billing nationally.

Key payers in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for the procedure, a description of typical sites of service (hospital OR or ambulatory surgical center), and an outline of common billing considerations tied to the service line. The publication highlights benchmarks and policy-relevant topics affecting authorization, bundling with radiation therapy services, and documentation needs for lymph node sampling and tissue submission. It also summarizes where to expect variation across payers and settings.

This summary provides a concise reference for revenue cycle managers, surgical and radiation oncology teams, and compliance staff seeking to understand how CPT code 55862 maps to clinical workflow, site-of-service patterns, and payer coverage considerations at a national level.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare55862CPTprostate surgerybrachytherapy accesslymph node samplingsurgical oncologyambulatory surgical centerhospital operating room

Billing Code Overview

CPT code 55862 describes a surgical procedure in which the provider makes an incision in the perineum to access the prostate for placement of radioactive material (brachytherapy) to treat malignant prostate cancer. The procedure includes sampling of nearby lymph nodes with submission of those tissues to a laboratory for pathological analysis.

Service type: Surgical prostate access with lymph node sampling and tissue submission for pathology
Typical site of service: Hospital operating room or ambulatory surgical center

Clinical & Coding Specifications

Clinical Context

A typical patient is a man in his 60s or 70s with biopsy-proven localized or locally advanced prostate adenocarcinoma referred for definitive brachytherapy or combined modality treatment. The urologist performs a perineal incision to access the prostate for placement of radioactive seeds (often by a radiation oncologist) and concurrently samples regional pelvic lymph nodes for staging; tissue specimens are submitted to pathology. The clinical workflow includes preoperative evaluation (PSA, imaging such as transrectal ultrasound or MRI, anesthesia assessment), informed consent discussing risks (bleeding, infection, urinary retention, erectile dysfunction), intraoperative coordination between urology and radiation oncology (seed/implant placement, fluoroscopic or ultrasound guidance), lymph node sampling with labeling and submission to the lab, postoperative recovery with monitoring and discharge instructions, and pathology/radiation therapy planning based on nodal status and final pathology.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — standard reporting	Use for routine reporting when no special circumstances apply
`11`	Principal or most significant procedure

CPT 55801: Perineal Prostatectomy for Obstructive Prostate Disease

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

CPT 55865: Perineal Prostate Incision with Lymph Node Sampling

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

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

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-55812-radical-perineal-prostatectomy

CPT 55812: Radical Perineal Prostatectomy for Prostate Cancer

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

CPT 55815: Perineal Prostatectomy with Lymph Node Dissection

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

CPT 55845: Radical Prostatectomy with Pelvic Lymph Node Dissection

Showing 1–10 of 11

Taxonomy Code	Specialty	Notes
208000000X	Urology	Primary surgical specialty performing the perineal prostate approach and lymph node sampling
2084P0800X	Radiation Oncology	Radiation oncologist involved for radioactive seed placement and implant planning
207L00000X	Pathology	Pathologist receives and interprets lymph node and prostate tissue specimens
363A00000X	Anesthesiology	Provides monitored anesthesia care, regional, or general anesthesia for the procedure
207K00000X	Surgical Oncology	May be involved for complex oncologic resection or multidisciplinary cases

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C61`	Malignant neoplasm of prostate	Primary indication for perineal prostate access and brachytherapy implant
`N40`	Benign prostatic hyperplasia	Common comorbidity affecting perioperative urinary function and planning
`R33.9`	Retention of urine, unspecified	Potential perioperative complication requiring management after prostate procedures
`N32.0`	Interstitial cystitis (chronic pelvic pain)	Relevant for differential diagnosis of pelvic pain and urinary symptoms pre- and post-procedure
`N42.9`	Disorder of prostate, unspecified	Used for non-specific prostate-related symptoms when definitive diagnosis pending
`C79.51`	Secondary malignant neoplasm of bone	Relevant when metastatic disease is present and affects overall treatment planning
`Z90.49`	Acquired absence of other organs and tissue	Relevant in complex surgical histories affecting approach or risk stratification

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`55700`	Biopsy, prostate; needle or punch, single or multiple, any method	May be performed preoperatively for diagnosis prior to definitive implant with `55862`
`55866`	Radical retropubic prostatectomy, with or without pelvic lymph node dissection	Alternative definitive surgical treatment for prostate cancer; sometimes performed when open surgical removal is chosen instead of perineal implant approach
`55873`	Laparoscopy, surgical prostatectomy, retropubic radical, with bilateral pelvic lymphadenectomy	Minimally invasive alternative for prostatectomy and pelvic node staging in related workflows
`77778`	Therapeutic radiopharmaceuticals via brachytherapy (interstitial)	Represents the therapeutic radioactive implant component commonly performed in conjunction with the perineal access provided by `55862` (often billed by radiation oncology)
`38500`	Biopsy or excision of lymph node(s); open, superficial	CPT codes for lymph node sampling when an open approach is used in the pelvic region in conjunction with `55862`
`88305`	Level IV pathology, surgical pathology, gross and microscopic examination	Typical specimen-level pathology reporting code used for lymph node or prostate tissue submitted after `55862`

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