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Billing code 54861: EpididymectomyMedicare rate & RVUs

Reported for operative removal of both epididymides when bilateral disease or symptoms require definitive surgical treatment rather than unilateral excision or focal lesion removal.

CMS RVU26DEffective Oct 1, 2026109 payment localities28 Medicare services in 2024

Medicare pays $520.05 for 54861 nationally in a facility.

Medicare rate · 54861

Epididymectomy

Work RVUs
9.46
Total RVUs
15.57
Global days
090

National rate · 2026

$520.05

Facility setting, before claim adjustments.

See every locality for 54861 →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 54861 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 54861 covers

A urologist removes the epididymis on each side during an operation, generally in a facility setting. The procedure may be considered when both sides have disease or persistent symptoms requiring surgical treatment; it is more extensive than removing a localized cyst or other lesion. The operative report should establish that both epididymides were removed and describe the bilateral indication and procedure performed.

Report the bilateral service once; modifier 50 is inappropriate. When other procedures are performed in the same session, CMS applies the standard multiple procedure reduction: the highest-valued procedure is paid in full and the others at 50%. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. Assistant-at-surgery payment requires documented medical necessity. CMS does not permit co-surgeons or team surgery for this code.

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 54861 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

54861 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$481.95
Alaska*Unavailable$670.36
ArizonaUnavailable$509.12
ArkansasUnavailable$477.26
AtlantaUnavailable$531.80
AustinUnavailable$525.51
BakersfieldUnavailable$525.80
Baltimore/Surr. CntysUnavailable$546.69
BeaumontUnavailable$502.46
BrazoriaUnavailable$512.15

54861 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
54861 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 54861 rate is calculated

Each of 54861’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 · 54861

RVUs × geographic indexes × conversion factor

Work9.46

9.46 RVUs× 1.000 GPCI

Practice expense4.89

4.89 RVUs× 1.000 GPCI

Malpractice1.22

1.22 RVUs× 1.000 GPCI

Adjusted RVUs

15.5700

Conversion factor

$33.4009

Medicare rate

$520.05

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 54861

54861 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 54861

Epididymectomy

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)0The 150% bilateral adjustment doesn’t apply.
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 · 54861

Epididymectomy

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned 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 51 · payment effect

With and without the modifier

54861 without 51 · national facility

$520.05

Epididymectomy

54861-51 · Second procedure: 50%

$260.03

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

54861 compared with similar codes

Compare codes · National

5 codes, side by side

  • 54861

    Epididymectomy9.46 wRVU

    Not priced

  • 54860

    Epididymectomy6.78 wRVU

    Not priced

  • 54830

    Epididymal lesion5.86 wRVU

    Not priced

  • 54840

    Spermatocele removal5.14 wRVU

    Not priced

  • 54865

    Epididymal exploration5.63 wRVU

    Not priced

How to choose

54860Epididymectomy
54860 is the unilateral procedure. Use 54861 when both epididymides are removed; do not report modifier 50 with 54861.
54830Epididymal lesion
54830 addresses removal of a localized epididymal lesion. 54861 represents removal of both epididymides, not just a focal abnormality.
54840Spermatocele removal
54840 is directed to a spermatocele. Choose 54861 only when the operation removes both epididymides rather than treating the spermatocele alone.
54865Epididymal exploration
54865 describes exploration of the epididymis. It does not represent the bilateral removal performed under 54861.

Codes related to 54861

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

Codes related to 54861
CodeHow it relatesNational office range
Same family
54860EpididymectomyUnilateral removal; this code represents the bilateral procedure.No office rate
Used instead
54830Epididymal lesionFor focused removal of an epididymal lesion rather than bilateral organ removal.No office rate
54840Spermatocele removalFor removal of a spermatocele instead of both epididymides.No office rate
54800Epididymal biopsySamples epididymal tissue for diagnosis rather than removing both epididymides.No office rate
54865Epididymal explorationExplores the epididymis without the bilateral removal represented here.No office rate

54861 billing questions

How does this differ from 54860?

54861 describes removal on both sides; 54860 is the unilateral service. Document the side or sides treated in the operative report.

Should modifier 50 be appended?

No. The bilateral service is represented by this code, and CMS identifies modifier 50 as inappropriate.

Can a localized epididymal lesion be coded with this procedure?

A focused removal of an epididymal lesion or spermatocele is distinct from removing both epididymides. The operative report should support the actual extent of surgery.

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.

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 54861PPRRVU2026_Oct_nonQPP.csv, line 6,332 (RVU26D)

Open CMS sourceHow we calculate rates

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