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Billing code 54505: Testicular biopsyMedicare rate & RVUs

Reports surgical sampling of testicular tissue through an incision, commonly for evaluating infertility or azoospermia when tissue architecture is needed.

CMS RVU26DEffective Oct 1, 2026109 payment localities21 Medicare services in 2024

Medicare pays $193.06 for 54505 nationally in a facility.

Medicare rate · 54505

Testicular biopsy

Swap in your local Medicare rate.

Work RVUs
3.41
Total RVUs
5.78
Global days
010

National rate · 2026

$193.06

Facility setting, before claim adjustments.

See every locality for 54505 → · 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 54505 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 54505 covers

A urologist obtains a tissue sample from the testis through a surgical incision, generally with the patient in a procedural or operating-room setting. A typical indication is evaluating infertility or azoospermia when examination of testicular tissue can help assess spermatogenesis. The specimen is submitted for pathologic examination; the procedure code represents obtaining the tissue, not the pathologist’s interpretation.

Select this code for incisional tissue sampling, rather than percutaneous needle sampling. The operative note should identify the testis sampled, the incision and sampling performed, and the clinical reason. It has a 10-day global period, so related postoperative visits during that period are included. For bilateral procedures, modifier 50 is paid at 150%. When multiple procedures occur in one session, the highest-valued procedure is paid in full and others at 50%. An assistant at surgery is paid only when medical necessity is documented; 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 54505 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

54505 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$178.72
Alaska*Unavailable$247.77
ArizonaUnavailable$188.98
ArkansasUnavailable$176.95
AtlantaUnavailable$197.32
AustinUnavailable$195.41
BakersfieldUnavailable$195.83
Baltimore/Surr. CntysUnavailable$203.01
BeaumontUnavailable$186.21
BrazoriaUnavailable$190.23

54505 rates by state

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

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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
54505 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 54505 rate is calculated

Each of 54505’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 · 54505

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 3.41Practice expense 1.94Malpractice 0.43

5.7800 adjusted RVUs×$33.4009 conversion factor=$193.06

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

Payment rules and modifiers for 54505

54505 has a 10-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 54505

Testicular biopsy

RuleCMS valueWhat it means
Global period010Minor procedure: the day of the procedure plus 10 days after are 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.
Split (54/55/56)0.10/0.80/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 54505

Testicular biopsy

10-day global period ends

Oct 11, 2026

Covers Oct 1, 2026 through Oct 11, 2026 (11 days).

Visit on Oct 31, 2026

After the global period ends: visits and procedures are billed normally.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

54505 without 50 · national facility

$193.06

Testicular biopsy

54505-50 · Bilateral: 150%

$289.59

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

54505 compared with similar codes

Compare codes

54505 vs 54500 vs 54512 vs 54522: national Medicare rates

Swap in your local Medicare rate.

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

How to choose

54500Testicular biopsy
Choose 54505 when tissue is obtained through an incision; choose 54500 for needle sampling.
54512Testicular surgery
54512 represents excision of a testicular lesion. This code represents incisional tissue sampling, not removal of a focal lesion.
54522Partial orchiectomy
54522 involves partial removal of the testis. Use 54505 when the service is tissue sampling rather than removal of a testicular portion.

Codes related to 54505

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

Codes related to 54505
CodeHow it relatesNational office range
Same family
54500Testicular biopsyNeedle sampling is the sibling method for testicular tissue biopsy.No office rate
Used instead
54512Testicular surgeryConsider for excision of a focal testicular lesion rather than sampling tissue.No office rate
54522Partial orchiectomyInvolves partial testicular removal, rather than a limited diagnostic tissue sample.No office rate

54505 billing questions

How does this differ from 54500?

54505 is for tissue obtained through an incision. Use 54500 for needle sampling.

Can pathology be billed separately?

Yes. This code represents obtaining the testicular tissue; a separately performed pathologic examination is reported by the appropriate pathology service.

How is a bilateral biopsy reported?

When both testes are biopsied, report modifier 50; CMS pays the bilateral procedure at 150%.

Are postoperative visits separately payable during the global period?

Related postoperative visits during the 10-day global period are included in the procedure.

What documentation supports incisional sampling?

Document the indication, the testis sampled, and the surgical incision and tissue acquisition. The record should make clear that the method was incisional rather than needle sampling.

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 54505PPRRVU2026_Oct_nonQPP.csv, line 6,309 (RVU26D)

Open CMS sourceHow we calculate rates

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