Billing code 54800: Epididymal biopsyMedicare rate & RVUs in Delaware
A surgeon samples epididymal tissue for histopathologic evaluation when a focal abnormality requires tissue diagnosis rather than lesion excision or epididymis removal.
CMS doesn’t publish an office rate for 54800 in Delaware.
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 9 sections
What 54800 covers
A urologist obtains a tissue sample from the epididymis for pathologic examination, commonly to evaluate an abnormal area that requires a tissue diagnosis. The service involves sampling epididymal tissue; it is distinct from removing a defined lesion, excising a spermatocele, or removing the epididymis. It may be performed in an operating room or an ambulatory surgical setting.
Report 54800 when the documented service is an epididymal biopsy, and retain the operative note describing the sampled site, laterality, clinical indication, and tissue submitted for examination. The code has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. For bilateral biopsy, modifier 50 is paid at 150%. An assistant 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.
54800 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | Unavailable | $110.35 |
How the 54800 rate is calculated
Each of 54800’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 · 54800
RVUs × geographic indexes × conversion factor
Work2.27
2.27 RVUs× 1.000 GPCI
Practice expense0.78
0.78 RVUs× 1.000 GPCI
Malpractice0.28
0.28 RVUs× 1.000 GPCI
Adjusted RVUs
3.3300
Conversion factor
$33.4009
Medicare rate
$111.22
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 54800
The CMS indicators that decide how 54800 is paid alongside other services.
CMS payment indicators · 54800
Epididymal biopsy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
54800 without 50 · national facility
$111.22
Epididymal biopsy
54800-50 · Bilateral: 150%
$166.83
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).
54800 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 54830Epididymal lesion
- 54800 represents tissue sampling for diagnosis; 54830 is for excision of a defined epididymal lesion.
- 54840Spermatocele removal
- Choose 54840 for spermatocele excision, with or without epididymectomy; 54800 describes a biopsy rather than removal of the spermatocele.
- 54860Epididymectomy
- 54860 is unilateral removal of the epididymis. Use 54800 when the service is limited to obtaining tissue for diagnosis.
- 54865Epididymal exploration
- 54865 describes epididymal exploration and includes the possibility of biopsy. Do not separately report 54800 for biopsy work included in the exploration.
54800 billing questions
How is 54800 different from excision of an epididymal lesion?
Use 54800 when tissue is sampled for diagnosis. When the surgeon removes a defined lesion, consider 54830 instead.
Can 54800 be reported with epididymal exploration?
54865 includes exploration with or without biopsy. Do not separately report 54800 for biopsy work included in that exploration.
How should bilateral biopsies be reported?
Report modifier 50 when the biopsy is performed bilaterally. CMS pays the bilateral service at 150%; document the sampled sites on both sides.
What documentation supports 54800?
The operative note should identify the epididymal site sampled, laterality, reason for biopsy, and tissue submitted for pathologic examination.
Can an assistant surgeon be paid for this procedure?
Assistant-at-surgery payment is available only when the record supports medical necessity. Co-surgeons and team surgery are 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
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