Question 1

Does Medicare cover radical prostatectomy for prostate cancer?

Accepted Answer

Yes. Medicare covers radical prostatectomy (laparoscopic CPT 55866, open CPT 55810) for prostate cancer when medically necessary. Medicare pays 80% of the approved amount under Part A (inpatient, DRG 709 — $13,310 in 2026) or Part B (outpatient). Most prostatectomies require inpatient admission. This calculator covers the surgical procedure cost only — hormone therapy (Part B injections or Part D oral medications) and radiation are billed separately.

Question 2

Is robotic prostatectomy covered by Medicare?

Accepted Answer

Yes. Medicare covers robot-assisted laparoscopic radical prostatectomy (CPT 55866) the same as open or standard laparoscopic prostatectomy. There is no Medicare billing code for the robotic system itself — it is bundled into the facility fee. Your surgeon fee and facility fee coverage are the same regardless of whether robotic or open technique is used. Some hospitals charge higher facility fees for robotic surgery; confirm with your facility what the expected charges are.

Question 3

What is the Medicare cost for radical prostatectomy?

Accepted Answer

In 2026, the surgeon fee for laparoscopic radical prostatectomy (CPT 55866) is approximately $1,216 nationally (your 20%: $243). For inpatient cases (DRG 709), Medicare pays the hospital $13,310; you pay the $1,736 Part A deductible. The surgeon bills separately under Part B. Anesthesia adds $700–$1,200 (your 20%: $140–$240). Total out-of-pocket without Medigap: approximately $2,100–$2,200. With Medigap Plan G: $283 (the Part B annual deductible).

Question 4

Why does this calculator show a different amount than Medicare.gov's cost estimate?

Accepted Answer

This calculator may show a higher number than Medicare.gov's "Patient Pays (average)" for several reasons: (1) Deductible timing — this calculator applies the $283 Part B annual deductible if it has not yet been met; Medicare.gov's average assumes many patients have already satisfied theirs. (2) Anesthesia — Medicare.gov's estimate covers the facility fee and surgeon only; anesthesia is billed separately and is included in this calculator. (3) Location adjustment — surgeon fees are adjusted by your region's Geographic Practice Cost Index (GPCI); in high-cost cities like Seattle or New York, surgeon fees run 30–50% above the national rate. Facility fees (HOPD and ASC) are nationally fixed by CMS and should match Medicare.gov exactly. (4) Patient mix — Medicare.gov's "Patient Pays" average includes Medigap enrollees who pay $0 coinsurance, which pulls the reported average below what uninsured Original Medicare patients typically pay.

Cost Component	Medicare-Approved Amount	Your Share (20%)
Surgeon Fee — Radical Prostatectomy (CPT 55866)	$1,081	$216
Hospital Outpatient (HOPD) Facility Fee	$10,860	$2,172
Ambulatory Surgery Center (ASC) Facility Fee	$5,120	$1,024
Inpatient Hospital (DRG 708) — Medicare Pays	$11,164	$1,736 Part A deductible
Anesthesia (estimated)	$700–$1,200	20% of approved

Medicare Radical Prostatectomy Cost 2026 | Out-of-Pocket Estimator

2026 Medicare Cost Summary — Radical Prostatectomy (CPT 55866)

What Medicare Pays

About This Calculator