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Billing code 54500: Testicular biopsyMedicare rate & RVUs

Reports needle sampling of testicular tissue through the scrotal skin, typically for diagnostic evaluation when a percutaneous biopsy approach is performed.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $67.14 for 54500 nationally in a facility.

Medicare rate · 54500

Testicular biopsy

Swap in your local Medicare rate.

Work RVUs
1.28
Total RVUs
2.01
Global days
000

National rate · 2026

$67.14

Facility setting, before claim adjustments.

See every locality for 54500 → · Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

On this page 10 sections
  1. Medicare rate
  2. What 54500 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 54500 covers

A urologist obtains a small sample of testicular tissue by passing a needle through the scrotal skin. The procedure may be performed in an office or facility setting when tissue sampling is needed for diagnostic evaluation, including selected infertility or suspected testicular disease workups. The route matters: this code describes needle sampling, not an incisional biopsy or excision of a testicular lesion.

Report the service when the record supports the indication, percutaneous needle approach, testis sampled, and tissue obtained. Same-day preoperative and postoperative care is included in the 0-day global period. For bilateral performance, modifier 50 is paid at 150%. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and the others at 50%. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 54500 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

54500 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$62.44
Alaska*Unavailable$87.35
ArizonaUnavailable$65.78
ArkansasUnavailable$61.86
AtlantaUnavailable$68.64
AustinUnavailable$67.72
BakersfieldUnavailable$67.69
Baltimore/Surr. CntysUnavailable$70.48
BeaumontUnavailable$65.04
BrazoriaUnavailable$66.13

54500 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
54500 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 54500 rate is calculated

Each of 54500’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 54500

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 1.28Practice expense 0.57Malpractice 0.16

2.0100 adjusted RVUs×$33.4009 conversion factor=$67.14

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 54500

The CMS indicators that decide how 54500 is paid alongside other services.

CMS payment indicators · 54500

Testicular biopsy

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

54500 without 50 · national facility

$67.14

Testicular biopsy

54500-50 · Bilateral: 150%

$100.71

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

54500 compared with similar codes

Compare codes

54500 vs 54505 vs 54512 vs 54522: national Medicare rates

Swap in your local Medicare rate.

  • 54500
    Testicular biopsy · 1.28 wRVU
    —
  • 54505
    Testicular biopsy · 3.41 wRVU
    —
  • 54512
    Testicular surgery · 9.1 wRVU
    —
  • 54522
    Partial orchiectomy · 9.99 wRVU
    —

How to choose

54505Testicular biopsy
Choose 54500 for percutaneous needle sampling. Choose 54505 when the biopsy is obtained through an incision.
54512Testicular surgery
54512 describes excising a testicular lesion. This code describes diagnostic tissue sampling with a needle, not lesion removal.
54522Partial orchiectomy
54522 describes partial removal of a testis. Use this code for needle biopsy when tissue sampling, rather than partial organ removal, is performed.

Codes related to 54500

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 54500
CodeHow it relatesNational office range
Same family
54505Testicular biopsyIncisional testicular biopsy; differs from this code's percutaneous needle approach.No office rate
Often billed with
88305Tissue pathology examMay report pathology examination of submitted testicular biopsy tissue when performed.$63.46–$92.44
Used instead
54512Testicular surgeryDescribes excision of a testicular lesion rather than needle sampling.No office rate

54500 billing questions

How does this differ from 54505?

54500 is for needle sampling through the scrotal skin. Use 54505 when the testicular biopsy is performed through an incision.

Can pathology be reported with the biopsy?

A pathology examination may be reported for the submitted tissue when that examination is performed and documented. The biopsy service describes obtaining the specimen; pathology describes its examination.

How is bilateral performance reported?

When the service is performed on both testes, report modifier 50; CMS pays the bilateral procedure at 150%.

What care is included in the global period?

The 0-day global period includes same-day preoperative and postoperative care.

Can an assistant or co-surgeon be billed?

Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeon and team-surgery billing are not permitted.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 54500PPRRVU2026_Oct_nonQPP.csv, line 6,308 (RVU26D)

Open CMS sourceHow we calculate rates

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