CPT 55867 Laparoscopic Prostate Reimbursement | OpenPayer

Summary & Overview

CPT 55867: Laparoscopic Partial Prostate Excision

CPT code 55867 represents a laparoscopic partial excision of the prostate gland and associated intraoperative maneuvers such as vasectomy, urethral incision/enlargement, and hemostasis. This code is used for minimally invasive urologic surgery and may be performed with robotic assistance. Nationally, procedures captured by this code are relevant for surgical utilization, facility planning, and payer coverage policies for advanced urologic interventions.

Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a national-level perspective on coverage and billing practice for this laparoscopic prostate procedure across major public and commercial payers.

Readers will find a concise clinical and billing overview, common billing contexts, and benchmarking and policy-related content where available. The report outlines expected service settings (hospital operating room or ambulatory surgical center) and clarifies the clinical scope of the code, including concurrent procedures noted in the code description. Data not provided in the input — such as specific payer policy language, fee schedules, and associated ICD-10 diagnoses — are identified as unavailable. This summary is intended to support coders, billing managers, and policy analysts seeking a clear national overview of CPT code 55867 and its clinical use.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare55867CPTurologylaparoscopic surgeryrobotic-assistedprostate surgeryambulatory surgeryoperative coding

Billing Code Overview

CPT code 55867 describes a laparoscopic excision of part of the prostate gland. The procedure includes removal of prostatic tissue via a minimally invasive abdominal approach, with additional procedures performed during the same operative session such as vasectomy, urethral incision and enlargement, and hemostatic measures to prevent blood loss. The description allows for robotic assistance when used.

Service type: Surgical — Laparoscopic/Minimally Invasive Urologic Surgery

Typical site of service: Hospital operating room or ambulatory surgical center (inpatient or outpatient surgical setting depending on clinical indications and facility capabilities)

Clinical & Coding Specifications

Clinical Context

A typical patient is a 65-year-old male with progressive lower urinary tract symptoms (urinary frequency, weak stream, incomplete emptying) and bladder outlet obstruction due to benign prostatic hyperplasia (BPH). Conservative therapies including alpha-blockers and 5-alpha-reductase inhibitors have failed or the prostate volume is large with persistent obstruction and recurrent urinary retention. Preoperative evaluation includes history and physical, urinalysis, PSA as indicated, transrectal or transabdominal imaging to estimate prostate size, and counseling on risks including bleeding, urinary incontinence, erectile dysfunction, and need for future interventions.

The planned operation is a laparoscopic simple prostatectomy (open or robot-assisted) using a transperitoneal or extraperitoneal approach to excise obstructing transition-zone prostatic tissue. Intraoperatively the surgeon may perform a concurrent vasectomy if requested or indicated for sterilization, may incise and enlarge the urethra (meatotomy or internal urethrotomy) if distal urethral stenosis exists, and will use hemostatic measures (sutures, cautery, topical agents) to control blood loss. Typical workflow: preop anesthesia assessment; general anesthesia with patient in lithotomy or low lithotomy/steep Trendelenburg as appropriate; port placement and laparoscopic or robot docking; enucleation or excision of adenomatous tissue; control of bleeding; optional adjunct procedures (vasectomy, urethral incision); placement of urethral catheter and bladder irrigation if needed; PACU recovery and short inpatient observation given expected blood loss and need for catheter management.

Typical site of service: hospital inpatient or hospital outpatient surgery center with laparoscopic/robotic capability.

Procedure context: billed under 55867 for laparoscopic excision of prostate (simple prostatectomy), possibly with robotic assistance; may be bundled with or accompanied by related procedural codes depending on additional distinct procedures and payer rules.

Coding Specifications

CPT 55869: Laparoscopic Retropubic Radical Prostatectomy with Bilateral Pelvic Lymphadenectomy

CPT-55868-LAPAROSCOPIC-RETROPUBIC-RADICAL-PROSTATECTOMY-NERVE-SPARING

CPT 55868: Laparoscopic Retropubic Radical Prostatectomy, Nerve‑Sparing

CPT-55866-LAPAROSCOPIC-RADICAL-PROSTATECTOMY-RETROPUBIC

CPT 55866: Laparoscopic Radical Prostatectomy, Retropubic

Taxonomy Code	Specialty	Notes
`208100000X`	Urology	Primary specialty performing laparoscopic/robotic simple prostatectomy.
`208D00000X`	General Surgery	General surgeons with advanced minimally invasive skills may perform in some centers.
`208U00000X`	Male Reproductive Medicine/Andrology	Specialists involved when concurrent vasectomy or fertility counseling is relevant.
`2084P0800X`	Thoracic Surgery	Not typical—listed only if advanced MIS expertise exists (rare).
`207RC0000X`	Colorectal Surgery	May participate when pelvic dissection complexity requires multidisciplinary care.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N40.1`	Enlarged prostate with lower urinary tract symptoms	Primary indication for simple prostatectomy when medical therapy fails and obstruction persists.
`N40.0`	Enlarged prostate without lower urinary tract symptoms	May be present as diagnosis code if enlargement documented; symptomatic disease guides need for surgery.
`N13.8`	Other obstructive and reflux uropathy	Used when chronic obstruction has produced upper tract changes contributing to surgical decision-making.
`N13.9`	Obstructive and reflux uropathy, unspecified	General code for urinary obstruction when specifics are not documented.
`N32.0`	Bladder neck obstruction	Relevant when obstruction is at bladder neck and adjunct urethral incision/enlargement is performed.
`R33.9`	Retention of urine, unspecified	Acute or chronic urinary retention is a common presentation leading to surgical intervention.
`I97.3`	Postprocedural hemorrhage and hematoma of a urinary system organ and urethra	Possible postoperative complication; relevant for documentation of bleeding events.
`N42.2`	Hematospermia	May be an associated symptom prompting evaluation; less commonly a primary indication.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`55866`	Prostatectomy, suprapubic, retropubic, or perineal (open) - simple prostatectomy (partial)	Alternative open approach for large BPH when laparoscopy is not used; may be chosen if minimally invasive approach not feasible.
`55840`	Radical prostatectomy, retropubic, with or without nerve-sparing	Different procedure for prostate cancer involving whole gland removal; not a simple prostatectomy but related in preop workup differentiating benign vs malignant disease.
`52601`	Transurethral resection of prostate (TURP)	Endoscopic alternative to simple prostatectomy for smaller prostates or when less invasive therapy is indicated; may be performed before or instead of `55867`.
`55250`	Vasectomy, bilateral or unilateral	Represents the vasectomy component when performed concurrently; if separately reportable per payer rules, bill with appropriate modifier.
`52210`	Cystourethroscopy, with or without ureteral catheterization	Diagnostic or intraoperative cystoscopy commonly performed before, during, or after prostate excision to inspect urinary tract and guide hemostasis.
`37220`	Vascular embolization, any method, for pelvic hemorrhage	Used in rare cases for postoperative bleeding control; may be performed if bleeding persists despite surgical hemostasis.

`62`	Two surgeons	Use when two surgeons work together as primary surgeons during portions of the procedure requiring distinct technical skills.
`63`	Procedure performed on infants less than 4 kg	Rarely applicable; use only if patient meets weight/age criteria per CMS.
`66`	Surgical team	Use when a surgical team is used and billed per payer policy.
`80`	Assistant surgeon	Use when an assistant surgeon provided assistance and payer requires modifier to indicate assistant.
`81`	Minimum assistant surgeon	Use when an assistant provides minimal assistance.
`82`	Assistant surgeon (when qualified resident not available)	Use when qualified resident not available and assistant surgeon performed services.
`52`	Reduced services	Use when procedure is partially reduced or not completed as planned.
`53`	Discontinued procedure	Use when procedure is started but discontinued due to extenuating circumstances.
`74`	Return to the operating room for a related procedure during the global period (after initial anesthesia)	Use if the patient returns to OR for a related procedure during the global period.
`78`	Unplanned return to the operating room for a related procedure during the postoperative period	Use for an unplanned reoperation during the global period.
`63`	Procedure performed on infants less than 4 kg	Duplicate intentionally excluded in selection; see above.
`23`	Unusual anesthesia	Use when general anesthesia is not used due to unusual circumstances and payer allows billing for unusual anesthesia.
`22`	Increased procedural services	Use when work required is substantially greater than typically required.
`50`	Bilateral procedure	Use if a procedure is performed bilaterally and the CPT supports bilateral modifier reporting.

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