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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.

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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

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CPT 55874: Image-Guided Prostate Biodegradable Spacer Injection

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Billing Code Overview

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.
`50`	Bilateral procedure	Use when the procedure is reported as bilateral by payer rules (rare for perineal spacer but included if payer requires bilateral modifier).
`51`	Multiple procedures	Use when multiple distinct procedures are billed the same day and payer requires a multiple-procedure modifier.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as documented.
`53`	Discontinued procedure	Use when the procedure is started but discontinued due to extenuating circumstances.
`59`	Distinct procedural service	Use to indicate a separate and distinct procedure from other services on the same day when documentation supports distinctness.
`62`	Two surgeons	Use when two surgeons work together as co-surgeons for distinct portions of the procedure and payer recognizes co-surgeon reporting.
`76`	Repeat procedure by same physician	Use when the same physician repeats the procedure later the same day.
`78`	Unplanned return to the operating room	Use when the patient returns to the OR for a related procedure during the postoperative period.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when an unrelated procedure is performed during the global period.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services in ambulatory surgical center	Use when advanced practice clinicians provide services in ASCs per payer rules.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures	Use if anesthesia services for the case meet medical direction criteria.
`QY`	Medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist	Use if applicable for billed anesthesia services.

Taxonomy Code	Specialty	Notes
2084P0800X	Urology	Urologists commonly perform perineal access and spacer placement.
2084R0202X	Radiation Oncology	Radiation oncologists often coordinate and perform spacer placement in conjunction with radiation planning.
363LF0000X	Interventional Radiology	Interventional radiologists may perform image-guided transperineal injections when involved.
208D00000X	General Surgery	Some surgical specialists with transperineal experience may perform the procedure in certain settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C61`	Malignant neoplasm of prostate	Primary indication for placement of a rectal spacer to reduce radiation dose to rectum during external-beam radiation therapy.
`D07.5`	Carcinoma in situ of prostate	Used when in situ malignant changes are being treated and separation is desired for focal radiation.
`N40.0`	Benign prostatic hyperplasia with lower urinary tract symptoms	May be present as a comorbidity affecting approach to anesthesia and peri-procedural urinary management.
`N32.0`	Bladder neck obstruction	Relevant if urinary retention risk alters peri-procedural planning or necessitates catheterization.
`K62.5`	Hemorrhage of anus and rectum	Considered in risk assessment; active rectal bleeding may alter timing of spacer placement.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`55874`	Insertion of biodegradable material between prostate and rectum via transperineal injection under image guidance	Primary procedure: placement of a spacer to separate prostate and rectum prior to radiation therapy.
`76942`	Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation	Commonly reported when transrectal or transperineal ultrasound guidance is used for needle localization during spacer injection.
`77012`	CT guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation	Used when CT imaging guidance is employed for needle placement during spacer insertion.
`51840`	Implantation of catheter for urinary drainage (eg, suprapubic)	Performed when peri-procedural urinary drainage is required or complications necessitate suprapubic catheter placement.
`51702`	Irrigation of urinary catheter, simple	May be used post-procedure if catheter care or irrigation is required during recovery.
`99212`	Office or other outpatient visit for evaluation and management, low complexity	Typical pre-procedure or post-procedure E/M visit level often reported in the clinical workflow.

CPT 55870: Electroejaculation and Semen Collection for Assisted Reproduction

CPT-55873-PROSTATE-CRYOABLATION-ULTRASOUND-GUIDED

CPT 55873: Ultrasound-Guided Prostate Cryoablation

CPT-55875-PROSTATE-SEED-IMPLANTATION-BRACHYTHERAPY-NEEDLE-PLACEMENT

CPT 55875: Prostate Seed Implantation, Needle/Catheter Placement

CPT-55876-PROSTATE-FIDUCIAL-MARKER-PLACEMENT-FOR-RADIOTHERAPY

CPT 55876: Prostate Marker or Dosimetry Device Placement for Radiotherapy

CPT-55877-PROSTATE-IRE-ABLATION-PERCUTANEOUS

CPT 55877: Prostate Tumor Ablation with Irreversible Electroporation

CPT-55880-TRANSRECTAL-HIFU-PROSTATE-ABLATION

CPT 55880: Transrectal HIFU Ablation of Malignant Prostate Tissue

CPT-55881-TRANSURETHRAL-ULTRASOUND-ABLATION-PROSTATE-MRI-GUIDED

CPT 55881: Transurethral Ultrasound Ablation (TULSA) of Prostate Tissue

CPT-55882-TRANSURETHRAL-ULTRASOUND-ABLATION-PROSTATE-MRI-GUIDED

CPT 55882: MRI-Guided Transurethral Ultrasound Ablation of Prostate Tissue

CPT-55899-MALE-GENITAL-SYSTEM-UNLISTED-PROCEDURE

CPT 55899: Unlisted Procedure, Male Genital System

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

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.
`50`	Bilateral procedure	Use when the procedure is reported as bilateral by payer rules (rare for perineal spacer but included if payer requires bilateral modifier).
`51`	Multiple procedures	Use when multiple distinct procedures are billed the same day and payer requires a multiple-procedure modifier.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as documented.
`53`	Discontinued procedure	Use when the procedure is started but discontinued due to extenuating circumstances.
`59`	Distinct procedural service	Use to indicate a separate and distinct procedure from other services on the same day when documentation supports distinctness.
`62`	Two surgeons	Use when two surgeons work together as co-surgeons for distinct portions of the procedure and payer recognizes co-surgeon reporting.
`76`	Repeat procedure by same physician	Use when the same physician repeats the procedure later the same day.
`78`	Unplanned return to the operating room	Use when the patient returns to the OR for a related procedure during the postoperative period.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when an unrelated procedure is performed during the global period.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services in ambulatory surgical center	Use when advanced practice clinicians provide services in ASCs per payer rules.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures	Use if anesthesia services for the case meet medical direction criteria.
`QY`	Medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist	Use if applicable for billed anesthesia services.

Taxonomy Code	Specialty	Notes
2084P0800X	Urology	Urologists commonly perform perineal access and spacer placement.
2084R0202X	Radiation Oncology	Radiation oncologists often coordinate and perform spacer placement in conjunction with radiation planning.
363LF0000X	Interventional Radiology	Interventional radiologists may perform image-guided transperineal injections when involved.
208D00000X	General Surgery	Some surgical specialists with transperineal experience may perform the procedure in certain settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C61`	Malignant neoplasm of prostate	Primary indication for placement of a rectal spacer to reduce radiation dose to rectum during external-beam radiation therapy.
`D07.5`	Carcinoma in situ of prostate	Used when in situ malignant changes are being treated and separation is desired for focal radiation.
`N40.0`	Benign prostatic hyperplasia with lower urinary tract symptoms	May be present as a comorbidity affecting approach to anesthesia and peri-procedural urinary management.
`N32.0`	Bladder neck obstruction	Relevant if urinary retention risk alters peri-procedural planning or necessitates catheterization.
`K62.5`	Hemorrhage of anus and rectum	Considered in risk assessment; active rectal bleeding may alter timing of spacer placement.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`55874`	Insertion of biodegradable material between prostate and rectum via transperineal injection under image guidance	Primary procedure: placement of a spacer to separate prostate and rectum prior to radiation therapy.
`76942`	Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation	Commonly reported when transrectal or transperineal ultrasound guidance is used for needle localization during spacer injection.
`77012`	CT guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation	Used when CT imaging guidance is employed for needle placement during spacer insertion.
`51840`	Implantation of catheter for urinary drainage (eg, suprapubic)	Performed when peri-procedural urinary drainage is required or complications necessitate suprapubic catheter placement.
`51702`	Irrigation of urinary catheter, simple	May be used post-procedure if catheter care or irrigation is required during recovery.
`99212`	Office or other outpatient visit for evaluation and management, low complexity	Typical pre-procedure or post-procedure E/M visit level often reported in the clinical workflow.

CPT 55870: Electroejaculation and Semen Collection for Assisted Reproduction

CPT-55873-PROSTATE-CRYOABLATION-ULTRASOUND-GUIDED

CPT 55873: Ultrasound-Guided Prostate Cryoablation

CPT-55875-PROSTATE-SEED-IMPLANTATION-BRACHYTHERAPY-NEEDLE-PLACEMENT

CPT 55875: Prostate Seed Implantation, Needle/Catheter Placement

CPT-55876-PROSTATE-FIDUCIAL-MARKER-PLACEMENT-FOR-RADIOTHERAPY

CPT 55876: Prostate Marker or Dosimetry Device Placement for Radiotherapy

CPT-55877-PROSTATE-IRE-ABLATION-PERCUTANEOUS

CPT 55877: Prostate Tumor Ablation with Irreversible Electroporation

CPT-55880-TRANSRECTAL-HIFU-PROSTATE-ABLATION

CPT 55880: Transrectal HIFU Ablation of Malignant Prostate Tissue

CPT-55881-TRANSURETHRAL-ULTRASOUND-ABLATION-PROSTATE-MRI-GUIDED

CPT 55881: Transurethral Ultrasound Ablation (TULSA) of Prostate Tissue

CPT-55882-TRANSURETHRAL-ULTRASOUND-ABLATION-PROSTATE-MRI-GUIDED

CPT 55882: MRI-Guided Transurethral Ultrasound Ablation of Prostate Tissue

CPT-55899-MALE-GENITAL-SYSTEM-UNLISTED-PROCEDURE

CPT 55899: Unlisted Procedure, Male Genital System

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 55874: Image-Guided Prostate Biodegradable Spacer Injection

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Billing Code Overview

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CPT 55874: Image-Guided Prostate Biodegradable Spacer Injection

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References