Summary & Overview
CPT 55875: Prostate Seed Implantation, Needle/Catheter Placement
CPT code 55875 covers the placement of needles or catheters into the prostate for subsequent placement of radioactive seeds (prostate brachytherapy). This procedure, performed by urologists or oncologists, is a key component of definitive or adjuvant localized prostate cancer treatment and has implications for procedural coding, facility billing, and multidisciplinary care coordination nationwide. Major payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise explanation of the clinical service represented by 55875, typical sites of service, and the reasons the code matters for national billing and coverage practices. The publication summarizes payer coverage patterns and billing considerations, highlights common reporting scenarios (including inclusion of concurrent cystoscopy), and provides benchmarks and policy updates relevant to clinicians, coding professionals, and health system administrators. The content also outlines the clinical context for prostate seed implantation and identifies areas where coding clarity influences reimbursement and documentation workflows.
Billing Code Overview
CPT code 55875 describes the placement of needles or catheters into the prostate for separate placement of radioactive "seeds" to treat prostate cancer. The procedure is performed by a urologist or oncologist and may be done independently or during a concurrent cystoscopy; if cystoscopy is performed, that procedure is included in 55875 and should not be reported separately.
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Service type: Brachytherapy source placement (interstitial prostate seed implantation)
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Typical site of service: Hospital outpatient setting, ambulatory surgical center, or specialized radiation oncology/procedural suite
Clinical & Coding Specifications
Clinical Context
A 68-year-old man with newly diagnosed, localized intermediate-risk prostate adenocarcinoma presents for definitive local therapy. The multidisciplinary team — including a urologist and radiation oncologist — recommends transperineal permanent radioactive seed implantation (brachytherapy). On the day of service the patient undergoes conscious sedation or general anesthesia in an ambulatory surgery center or hospital operating room. The urologist places needles or catheters into the prostate under transrectal ultrasound (TRUS) guidance for placement of radioactive seeds to deliver targeted radiation. Needle or catheter placement may occur during a concurrent cystoscopy; when cystoscopy is performed, it is included in the same session and not billed separately. Typical workflow includes preoperative localization and ultrasound planning, intraoperative needle placement and seed deposition, intraoperative dosimetry verification, and immediate postoperative recovery. Usual sites of service are an ambulatory surgery center, hospital outpatient department, or inpatient operating room depending on patient comorbidity and payor requirements.
Coding Specifications
- The following modifiers are the most clinically relevant for
55875. Use professional judgment and payer rules when applying modifiers.
| Modifier | Description | When to Use |
|---|---|---|