Billing code 54865: Epididymal explorationMedicare rate & RVUs in Redding

In Redding, Medicare pays $339.95 for 54865 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 54865 nationwide

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

What 54865 covers

A urologist surgically examines the epididymis, the coiled structure alongside the testis, to assess a suspected abnormality that requires direct operative evaluation. One clinical setting is male infertility evaluation when an epididymal blockage is suspected. The service is performed in an operative setting; it is distinct from taking tissue solely for biopsy or removing a defined lesion or the epididymis itself.

Report the exploration when the operative work is directed at assessing epididymal anatomy, and document the indication, side, surgical approach, and findings. CMS assigns a 90-day major-surgery global period, including the day-before preoperative visit and related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this code. 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.

How Redding compares for 54865

Across 109 of 109 payment localities, the facility rate for 54865 runs from $306.88 in Arkansas to $427.29 in Alaska*. Redding pays $339.95. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

54865 rates by state

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

See 54865 in every payment locality

How the 54865 rate is calculated

Each of 54865’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.

Payment rules and modifiers for 54865

54865 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

Codes related to 54865

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

How 54865 has changed in Redding

Price 54865 for an earlier date of service

Where the Redding rate applies

Redding is a Medicare payment area, not a city. Our Census mapping connects it to 32 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.

• 54865 in Redding
• 54865 in Anderson
• 54865 in Bella Vista
• 54865 in Big Bend
• 54865 in Burney
• 54865 in Cassel
• 54865 in Castella
• 54865 in Centerville

Browse all communities in California

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

Open CMS sourceHow we calculate rates