Summary & Overview
CPT 55874: Image-Guided Prostate Biodegradable Spacer Injection
CPT code 55874 covers image-guided perineal insertion and injection of biodegradable material around the prostate to create and maintain a temporary space between the prostate and rectum. The spacer is intended to reduce rectal radiation dose during prostate radiotherapy and can affect procedural planning, facility utilization, and radiation oncology workflows. Nationally, this code is significant as adoption influences practice patterns in prostate cancer radiation management and informs payer coverage policies for an adjunctive protective intervention.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical purpose of the procedure, common sites of service, and the principal payer landscape covered. The publication summarizes benchmarks and reimbursement contexts where available, highlights policy and coverage considerations relevant to national payers, and explains clinical context for radiation-sparing intent. It also outlines common modifier usage and coding considerations when data are available.
This summary serves clinicians, coding professionals, and policy analysts seeking concise, national-level information on CPT code 55874, including clinical rationale, expected settings of care, and which major payers are relevant for coverage discussions. Data not available in the input are noted where applicable in the full publication.
Billing Code Overview
CPT code 55874 describes a minimally invasive procedure in which, under imaging guidance, a provider inserts a needle through the perineum and injects one or more biodegradable materials around the prostate to maintain a space between the prostate and the rectum. The technique is used to physically separate the prostate from the rectum temporarily, typically to reduce radiation exposure to rectal tissue during prostate radiotherapy.
Service type: Image-guided perineal injection of biodegradable spacer around the prostate
Typical site of service: Outpatient surgical or ambulatory procedure setting, including ambulatory surgical centers or hospital outpatient departments
Clinical & Coding Specifications
Clinical Context
A typical patient is a 68-year-old man with localized prostate cancer scheduled to receive external-beam radiation therapy. To reduce rectal dose and lower the risk of radiation proctitis, the radiation oncology team arranges a spacer placement procedure. Under transrectal ultrasound or CT imaging guidance in an ambulatory surgery center or hospital outpatient department, a urologist or radiation oncologist inserts a needle percutaneously through the perineum and injects a biodegradable hydrogel around the posterior prostate to create and maintain separation between the prostate and rectum. The workflow includes pre-procedure informed consent, pre-op antibiotics as indicated, imaging localization, sterile perineal needle placement, spacer injection and imaging confirmation of separation, brief post-procedure observation for bleeding or urinary retention, and discharge with wound care and activity instructions. Typical site of service is an ambulatory surgical center or hospital outpatient department; sedation ranges from moderate sedation to monitored anesthesia care based on patient comorbidities and facility protocols.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician’s professional interpretation or services separate from facility or technical components. |