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Billing code 54560: Testicular explorationMedicare rate & RVUs

Reports operative inspection of a testis to investigate a suspected abnormality, whether or not the surgeon takes a biopsy during the exploration.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $623.26 for 54560 nationally in a facility.

Medicare rate · 54560

Testicular exploration

Swap in your local Medicare rate.

Work RVUs
11.8
Total RVUs
18.66
Global days
090

National rate · 2026

$623.26

Facility setting, before claim adjustments.

See every locality for 54560 → · 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 54560 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 54560 covers

A urologist surgically exposes and examines a testis when evaluation requires direct inspection of the organ. The surgeon may take a biopsy during the exploration. This is an operative service, generally performed in a surgical setting; it is distinct from obtaining a testicular biopsy alone or exploring for an undescended testis.

Report 54560 when the operative work is exploration of the testis, with or without biopsy. The operative note should identify the side, the reason for exploration, the findings, and whether a biopsy was obtained. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be allowed; co-surgeon payment requires supporting documentation, and team surgery is 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 54560 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

54560 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$579.14
Alaska*Unavailable$809.47
ArizonaUnavailable$610.50
ArkansasUnavailable$573.72
AtlantaUnavailable$637.38
AustinUnavailable$628.72
BakersfieldUnavailable$628.35
Baltimore/Surr. CntysUnavailable$654.51
BeaumontUnavailable$603.59
BrazoriaUnavailable$613.78

54560 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
54560 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 54560 rate is calculated

Each of 54560’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 · 54560

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 11.80Practice expense 5.36Malpractice 1.50

18.6600 adjusted RVUs×$33.4009 conversion factor=$623.26

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

Payment rules and modifiers for 54560

54560 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 54560

Testicular exploration

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 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)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
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 · 54560

Testicular exploration

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

54560 without 50 · national facility

$623.26

Testicular exploration

54560-50 · Bilateral: 150%

$934.89

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

54560 compared with similar codes

Compare codes

54560 vs 54500 vs 54505 vs 54550 vs 54512: national Medicare rates

Swap in your local Medicare rate.

  • 54560
    Testicular exploration · 11.8 wRVU
    —
  • 54500
    Testicular biopsy · 1.28 wRVU
    —
  • 54505
    Testicular biopsy · 3.41 wRVU
    —
  • 54550
    Testis exploration · 8.2 wRVU
    —
  • 54512
    Testicular surgery · 9.1 wRVU
    —

How to choose

54500Testicular biopsy
54500 describes needle biopsy of the testis. Use 54560 when the surgeon performs operative exploration, with or without biopsy.
54505Testicular biopsy
54505 describes an incisional testicular biopsy. Choose 54560 when the service is testicular exploration rather than biopsy alone.
54550Testis exploration
54550 is for exploration of an undescended testis. 54560 is used for exploration of a testis for another suspected abnormality.
54512Testicular surgery
54512 is for excision of a testicular lesion. Use 54560 when the operative service is exploration, not removal of a lesion.

Codes related to 54560

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

Codes related to 54560
CodeHow it relatesNational office range
Used instead
54500Testicular biopsyNeedle biopsy alone, rather than operative exploration of the testis.No office rate
54505Testicular biopsyIncisional biopsy alone, rather than operative exploration of the testis.No office rate
54550Testis explorationExploration directed at an undescended testis.No office rate
54512Testicular surgeryExcision of a testicular lesion when removal, rather than exploration, is performed.No office rate
54522Partial orchiectomyPartial testicular removal when the operative treatment is excision of part of the testis.No office rate
54530OrchiectomyRadical removal of the testis rather than exploration alone.No office rate

54560 billing questions

When should 54560 be reported instead of a testicular biopsy code?

Use 54560 when the operative service is exploration of the testis, whether or not a biopsy is taken. A biopsy code is for a biopsy service without the broader testicular exploration.

Does 54560 include a biopsy performed during the exploration?

Yes. The exploration code includes the option of taking a biopsy during the procedure; do not report a separate biopsy code for that work.

How is bilateral exploration reported?

CMS lists bilateral reporting with modifier 50 and payment at 150%. The operative documentation should support that both testes were explored.

What postoperative care is included in the global period?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

Can an assistant or co-surgeon be reported?

CMS permits assistant-at-surgery payment. Co-surgeon payment requires supporting documentation; team surgery is 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 54560PPRRVU2026_Oct_nonQPP.csv, line 6,316 (RVU26D)

Open CMS sourceHow we calculate rates

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