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Billing code 54830: Epididymal lesionMedicare rate & RVUs

Reports surgical removal of a localized epididymal lesion when the surgeon excises the abnormal tissue rather than taking a diagnostic sample or removing the entire epididymis.

CMS RVU26DEffective Oct 1, 2026109 payment localities384 Medicare services in 2024

Medicare pays $347.70 for 54830 nationally in a facility.

Medicare rate · 54830

Epididymal lesion

Swap in your local Medicare rate.

Work RVUs
5.86
Total RVUs
10.41
Global days
090

National rate · 2026

$347.70

Facility setting, before claim adjustments.

See every locality for 54830 → · 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 54830 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 54830 covers

A urologist uses this service to remove a localized abnormality arising in the epididymis, the coiled structure alongside the testicle. The procedure is typically performed in an operating room, often for a palpable or imaging-identified mass requiring excision. The surgeon removes the lesion while retaining the remaining epididymis when feasible; the tissue may be submitted for pathologic examination. A spermatocele has its own procedure code, so the specific lesion being treated matters when selecting the service.

Report this code when the operative record supports excision of a localized epididymal lesion, not biopsy alone or removal of the whole epididymis. Document the lesion, operative findings, and what tissue was removed. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For same-session procedures, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. 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 54830 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

54830 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$320.66
Alaska*Unavailable$442.06
ArizonaUnavailable$340.05
ArkansasUnavailable$317.31
AtlantaUnavailable$355.54
AustinUnavailable$352.43
BakersfieldUnavailable$353.32
Baltimore/Surr. CntysUnavailable$366.20
BeaumontUnavailable$334.52
BrazoriaUnavailable$342.40

54830 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
54830 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 54830 rate is calculated

Each of 54830’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 · 54830

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 5.86Practice expense 3.77Malpractice 0.78

10.4100 adjusted RVUs×$33.4009 conversion factor=$347.70

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

Payment rules and modifiers for 54830

54830 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 54830

Epididymal lesion

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)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 · 54830

Epididymal lesion

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

54830 without 50 · national facility

$347.70

Epididymal lesion

54830-50 · Bilateral: 150%

$521.55

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

54830 compared with similar codes

Compare codes

54830 vs 54800 vs 54840 vs 54860 vs 54865: national Medicare rates

Swap in your local Medicare rate.

  • 54830
    Epididymal lesion · 5.86 wRVU
    —
  • 54800
    Epididymal biopsy · 2.27 wRVU
    —
  • 54840
    Spermatocele removal · 5.14 wRVU
    —
  • 54860
    Epididymectomy · 6.78 wRVU
    —
  • 54865
    Epididymal exploration · 5.63 wRVU
    —

How to choose

54800Epididymal biopsy
54800 is for obtaining a diagnostic epididymal tissue sample. Choose 54830 when the surgeon removes a localized lesion rather than sampling it.
54840Spermatocele removal
54840 is the specific code for spermatocele excision. 54830 applies to excision of a different localized epididymal lesion.
54860Epididymectomy
54860 describes removal of the entire epididymis on one side. 54830 is for excision of a localized lesion while retaining the remaining epididymis.
54865Epididymal exploration
54865 describes surgical exploration of the epididymis. Use 54830 when the operative service includes excision of a localized lesion.

Codes related to 54830

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

Codes related to 54830
CodeHow it relatesNational office range
Used instead
54800Epididymal biopsyUsed for diagnostic tissue sampling of the epididymis rather than excision of a lesion.No office rate
54840Spermatocele removalSpecific procedure for excision of a spermatocele.No office rate
54860EpididymectomyUsed when the procedure removes the entire epididymis on one side.No office rate
54861EpididymectomyUsed when the procedure removes both epididymides.No office rate
54865Epididymal explorationDescribes epididymal exploration rather than excision of a localized lesion.No office rate

54830 billing questions

How does this differ from an epididymal biopsy?

Use 54830 when the surgeon excises the localized lesion. Code 54800 describes sampling epididymal tissue for diagnosis rather than removing the lesion.

Is a spermatocele reported with this code?

A spermatocele has a distinct excision code, 54840. Select based on the condition and procedure documented, rather than treating every epididymal cystic lesion as the same service.

Can this code be reported for bilateral lesions?

CMS identifies this as a bilateral procedure; bilateral reporting with modifier 50 is paid at 150%. The operative documentation should support treatment on both sides.

What postoperative care is included?

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

When is an assistant at surgery payable?

CMS allows assistant-at-surgery payment only when medical necessity is documented. Co-surgeons and team surgery are not permitted for this code.

What happens when another procedure is performed in the same session?

Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.

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 54830PPRRVU2026_Oct_nonQPP.csv, line 6,329 (RVU26D)

Open CMS sourceHow we calculate rates

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