CPT code 54861: Epididymectomy2026 Medicare rate & RVUs in Georgia
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 doesn’t publish an office rate for 54861 in Georgia.
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 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 in Georgia
| Payment locality | Office | Facility |
|---|---|---|
| Atlanta | Unavailable | $531.80 |
| Rest Of Georgia | Unavailable | $510.24 |
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| 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. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share 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.
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%).
54861 compared with similar codes
Compare codes · National
5 codes, side by side
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.
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
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