{
    "code": "55874",
    "coding_system": "CPT",
    "canonical_url": "https://localishealth.com/cpt/55874/2021/A",
    "release_specific_url": "https://localishealth.com/cpt/55874/2021/D",
    "description": "A needle is passed through the skin of the perineum, the area between the scrotum and anus, under ultrasound guidance, and an absorbable gel is injected into the thin space between the prostate and the front wall of the rectum. The gel pushes the rectum roughly a centimeter away from the prostate and holds it there for the duration of radiation treatment, so less of the rectal wall sits in the high-dose beam. The material dissolves and is cleared by the body over the following months.",
    "answer": {
        "question": "How much did Medicare pay for CPT 55874 in Q4 2021?",
        "text": "Medicare paid $3,260.76 for CPT 55874 in the office (non-facility) setting and $166.44 in a facility under the Q4 2021 Physician Fee Schedule, effective October 2021. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This price has been unchanged since Q1 2021, when it increased 3.7%."
    },
    "release": {
        "schedule": "pfs",
        "year": 2021,
        "quarter": "D",
        "label": "Q4 2021",
        "effective": "October 1 – December 31, 2021",
        "revision": 1
    },
    "status": {
        "code": "A",
        "non_facility_payable": true,
        "facility_payable": true
    },
    "national_rates_usd": {
        "office_non_facility": 3260.76,
        "facility": 166.44,
        "sequestration_applied": false,
        "gpci": 1
    },
    "rvus": {
        "work": 3.03,
        "practice_expense_non_facility": 90.15,
        "practice_expense_facility": 1.47,
        "malpractice": 0.27
    },
    "formula": "(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor",
    "conversion_factor": 34.8931,
    "source": {
        "label": "Physician relative value file (Q4 2021)",
        "cms_url": "https://www.cms.gov/files/zip/rvu21d.zip",
        "local_source_url": "https://localishealth.com/sources/physician-fee-schedule/2021/D",
        "file": "PPRRVU21_OCT.csv",
        "row": 10865,
        "sha256": "f1972bd23bdc51795ceba7d536bb413a0ba0b47fad8c2ed594e7ee7799877297"
    },
    "modified_at": "2026-08-04T03:10:59+00:00"
}