CPT CODESurgery (Urinary/Reproductive)Status A

CPT Code 55869Complete Billing & Coding Guide (2026)Lap srg prst8ct bi pl lmphad

Reviewed by AAPC-Certified Coders2026 Medicare Fee ScheduleCMS + AMA Sources

Medicare Payment

$1329

Non-facility · National avg

Facility

$1329

Total RVU

39.78

Global

090

Payment

$1329

non-facility

Work RVU

27.41

physician effort

Global Period

090

post-op days

Bundling Edits

none found

Last reviewed: May 2026Reviewed by the Go Medical Billing Editorial TeamAAPC-certified coders

Overview Payment Coding Rules FAQ

About CPT 55869

CPT 55869 is a Current Procedural Terminology code in the Surgery (Urinary/Reproductive) category maintained by the American Medical Association. The CMS short descriptor reads "Lap srg prst8ct bi pl lmphad". For the full AMA long descriptor and clinical guidance, refer to the current CPT code manual.

Major surgical codes carry a 90-day global period that bundles all related post-operative care. Improper billing of post-op E/M (without modifier 24 for unrelated care) is a common audit finding. Documentation of medical necessity for the procedure itself remains the foundation of any successful claim.

Pro Tip

CPT 55869 has a 90-day global period. Any E/M visit within that window for the same condition is bundled into the procedure payment. Use modifier 24 for unrelated E/M, modifier 79 for unrelated procedures, and modifier 78 for related returns to the OR.

Code Properties

Global Period

090

90-day global period

Status Indicator

Active. Payment under Medicare PFS.

Conversion Factor

$33.4009

CMS national rate

Effective Date

2026-04-01

per CMS publication

RVU Breakdown

Every CPT code’s Medicare payment is calculated from three Relative Value Unit components: physician work, practice expense, and malpractice. Together they multiply by the conversion factor to produce the payment amount.

RVU Composition

39.78 total RVU

27.41

8.82

Work RVU

27.41 · 69%

Physician time + skill

Practice Expense

8.82 · 22%

Office & equipment

Malpractice

3.55 · 9%

Liability insurance

Non-Facility

Private office · urgent care · ambulatory

Most billed

$1328.69

39.78 RVU × $33.4009 CF

Facility

Hospital · ASC · nursing home

$1328.69

39.78 RVU × $33.4009 CF

Payment = Total RVU × Conversion Factor ($33.4009) × Geographic Adjustment (GPCI). National averages shown. Actual payment varies by locality.

Medicare Payment by State

Medicare adjusts payment by locality based on GPCI (Geographic Practice Cost Index). Higher cost-of-living areas like California and New York pay more. Rural states pay less. Top 12 states shown.

State

Non-Facility Payment

Non-Fac $

Facility

$1752

$1449

$1444

$1442

$1430

$1423

$1395

$1374

$1373

$1362

$1361

$1359

Showing top 12 of 53 states. Full locality data available in CMS PFS Locality file.

Applicable Modifiers

Modifiers commonly paired with 55869 based on its category. Apply only when the clinical circumstance warrants. Incorrect modifier use is a top audit target.

Increased procedural services — work substantially greater than typically required

When to use · When the work required for a procedure is substantially more than usual (e.g., morbid obesity, extensive adhesions, unusual anatomy). Request additional payment.

Preventive services — when the primary purpose is delivery of an evidence-based service per USPSTF A or B recommendation

When to use · Screening services (colonoscopy, mammography, etc.) to indicate the primary purpose is preventive. Waives cost-sharing under ACA.

Bilateral procedure — performed on both sides of the body during the same operative session

When to use · When a procedure is performed on both sides (e.g., bilateral knee injections, bilateral cataract surgery). Payment = 150% of unilateral rate.

Multiple procedures — when multiple procedures (other than E/M) are performed at the same session

When to use · Second and subsequent procedures during the same session. Payment is typically reduced to 50% for the 2nd procedure, 25% for the 3rd+.

Reduced services — when a procedure is partially reduced or eliminated at the physician's discretion

When to use · When a procedure is not completed to its full extent (e.g., incomplete colonoscopy that didn't reach cecum). Payment reduced by payer discretion.

Discontinued procedure — physician elected to terminate/discontinue a procedure due to patient risk

When to use · When a surgical procedure is started but discontinued due to patient safety concerns (e.g., anesthesia complications, intraoperative findings).

Surgical care only

When to use · When the surgeon provided ONLY the surgery, not pre/post op care

Postoperative management only

When to use · When you managed post-op but another physician performed the surgery

AR Recovery Note

Modifier 24, 79, 78, and 58 on global-period claims are the highest-recovery surgical billing levers. 55869 carries a 090 global indicator. Our team flags every encounter inside an active global period for the right modifier decision.

Free 90-Day AR Recovery Audit

Find the revenue leakage in your 55869 claims.

Wrong modifier, missing documentation, bundling without justification, stale ICD-10 linkage: these are the silent revenue killers on Surgery (Urinary/Reproductive) claims. Our AAPC-certified team audits your last 90 days of 55869 claims, surfaces the recoverable dollars, and appeals them. Free, no obligation.

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FAQ

Everything about CPT 55869

What does CPT code 55869 cover?

What is the Medicare payment for CPT 55869?

The national average Medicare payment for CPT 55869 is approximately $1328.69 in a non-facility setting and $1328.69 in a facility setting. Actual payment varies by locality based on GPCI adjustments. Total RVU is 39.78 with a conversion factor of $33.4009.

What is the global period for CPT 55869?

CPT 55869 has a 90-day global period (indicator 090). Routine post-op care for the next 90 days is bundled into the procedure payment, including all related E/M visits. Bill modifier 24 for unrelated E/M, modifier 79 for unrelated procedures, or modifier 78 for related returns to the OR during this window.

CMS Medicare Physician Fee ScheduleNCCI Edits · Current QuarterAMA CPT Code Set

CPT codes and descriptions are copyright of the American Medical Association. RVU values reflect current CMS publications. Actual payment varies by locality. Commercial payer rates vary by contract.

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We audit your last 90 days of claims and surface the revenue leakage: wrong modifiers, missed bundling appeals, ICD-10 specificity gaps. AAPC-certified coders. 2.49% of collections. No setup fees.

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