No office rate
Choose 54505 when tissue is obtained through an incision; choose 54500 for needle sampling.
On this page
CMS RVU26D · Effective 2026-10-01
54505 Testicular biopsy Medicare reimbursement rates in Delaware
Reports surgical sampling of testicular tissue through an incision, commonly for evaluating infertility or azoospermia when tissue architecture is needed. Compare 54505 office and facility rates across CMS payment localities in Delaware.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 54505 in Delaware?
Delaware has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$191.40
1 of 1 localities have a supported rate.
Payment area: Delaware
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Urology procedure
About 54505: Incisional testicular biopsy
Reports surgical sampling of testicular tissue through an incision, commonly for evaluating infertility or azoospermia when tissue architecture is needed.
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.
CMS billing rules for 54505
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU3.41 · 59%
- Practice expense (office) RVU1.94 · 34%
- Malpractice RVU0.43 · 7%
21
Medicare services in 2024 · #5900 by national volume
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.
54505 compared with similar codes
Office rates for Delaware, from the same CMS release.
No office rate
54512 represents excision of a testicular lesion. This code represents incisional tissue sampling, not removal of a focal lesion.
No office rate
54522 involves partial removal of the testis. Use 54505 when the service is tissue sampling rather than removal of a testicular portion.
Compare 54505 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Delaware →
Office / nonfacility
Unavailable
Facility
$191.40
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 54505 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
6,309
- Code
- 54505
- Physician work
- 3.41
- Practice expense
- 1.94
- Malpractice
- 0.43
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.41 | × 1.005 | 3.4270 |
| Practice expense | 1.94 | × 0.988 | 1.9167 |
| Malpractice | 0.43 | × 0.899 | 0.3866 |
| Total RVUs | 5.7303 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Delaware$191.40
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.41 | 1.005 |
| Practice expense | 1.94 | 0.988 |
| Malpractice | 0.43 | 0.899 |
(3.41 × 1.005 + 1.94 × 0.988 + 0.43 × 0.899) × $33.4009 = $191.40
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
6,30654440,,Repair of penis,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,30754450,,Preputial stretching,A,,1.09,0.91,,0.27,,0.15,2.15,1.51,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,30854500,,Biopsy of testis,A,,1.28,0.57,NA,0.57,,0.16,2.01,2.01,0,000,0.00,0.00,0.00,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,30954505,,Biopsy of testis,A,,3.41,1.94,NA,1.94,,0.43,5.78,5.78,0,010,0.10,0.80,0.10,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,31054512,,Excise lesion testis,A,,9.10,4.39,NA,4.39,,1.19,14.68,14.68,0,090,0.10,0.80,0.10,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,31154520,,Removal of testis,A,,5.17,3.25,NA,3.25,,0.73,9.15,9.15,0,090,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,31254522,,Orchiectomy partial,A,,9.99,4.74,NA,4.74,,1.29,16.02,16.02,0,090,0.10,0.80,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503