No office rate
54500 describes needle biopsy of the testis. Use 54560 when the surgeon performs operative exploration, with or without biopsy.
On this page
CMS RVU26D · Effective 2026-10-01
54560 Testicular exploration Medicare reimbursement rates in Guam
Reports operative inspection of a testis to investigate a suspected abnormality, whether or not the surgeon takes a biopsy during the exploration. Compare 54560 office and facility rates across CMS payment localities in Guam.
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 54560 in Guam?
Guam 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
$626.70
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
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 surgery
About 54560: Surgical testicular exploration
Reports operative inspection of a testis to investigate a suspected abnormality, whether or not the surgeon takes a biopsy during the exploration.
A urologist surgically exposes and examines a testis when evaluation requires direct inspection of the organ. The surgeon may take a biopsy during the exploration. This is an operative service, generally performed in a surgical setting; it is distinct from obtaining a testicular biopsy alone or exploring for an undescended testis.
Report 54560 when the operative work is exploration of the testis, with or without biopsy. The operative note should identify the side, the reason for exploration, the findings, and whether a biopsy was obtained. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be allowed; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 54560
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care 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 may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU11.80 · 63%
- Practice expense (office) RVU5.36 · 29%
- Malpractice RVU1.50 · 8%
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.
54560 compared with similar codes
Office rates for Guam, from the same CMS release.
No office rate
54505 describes an incisional testicular biopsy. Choose 54560 when the service is testicular exploration rather than biopsy alone.
No office rate
54550 is for exploration of an undescended testis. 54560 is used for exploration of a testis for another suspected abnormality.
No office rate
54512 is for excision of a testicular lesion. Use 54560 when the operative service is exploration, not removal of a lesion.
Compare 54560 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
Hawaii, Guam →
Office / nonfacility
Unavailable
Facility
$626.70
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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 54560 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
6,316
- Code
- 54560
- Physician work
- 11.80
- Practice expense
- 5.36
- Malpractice
- 1.50
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 11.80 | × 1.000 | 11.8000 |
| Practice expense | 5.36 | × 1.137 | 6.0943 |
| Malpractice | 1.50 | × 0.579 | 0.8685 |
| Total RVUs | 18.7628 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$626.70
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 11.8 | 1 |
| Practice expense | 5.36 | 1.137 |
| Malpractice | 1.5 | 0.579 |
(11.8 × 1 + 5.36 × 1.137 + 1.5 × 0.579) × $33.4009 = $626.70
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.
54560 billing questions
When should 54560 be reported instead of a testicular biopsy code?
Use 54560 when the operative service is exploration of the testis, whether or not a biopsy is taken. A biopsy code is for a biopsy service without the broader testicular exploration.
Does 54560 include a biopsy performed during the exploration?
Yes. The exploration code includes the option of taking a biopsy during the procedure; do not report a separate biopsy code for that work.
How is bilateral exploration reported?
CMS lists bilateral reporting with modifier 50 and payment at 150%. The operative documentation should support that both testes were explored.
What postoperative care is included in the global period?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
CMS permits assistant-at-surgery payment. Co-surgeon payment requires supporting documentation; team surgery is 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 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.
6,31354530,,Removal of testis,A,,8.25,4.69,NA,4.69,,1.11,14.05,14.05,0,090,0.10,0.80,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,31454535,,Extensive testis surgery,A,,12.86,5.66,NA,5.66,,1.65,20.17,20.17,0,090,0.10,0.80,0.10,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,31554550,,Exploration for testis,A,,8.20,4.25,NA,4.25,,1.07,13.52,13.52,0,090,0.10,0.80,0.10,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,31654560,,Exploration for testis,A,,11.80,5.36,NA,5.36,,1.50,18.66,18.66,0,090,0.10,0.80,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,31754600,,Reduce testis torsion,A,,7.45,4.08,NA,4.08,,0.96,12.49,12.49,0,090,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,31854620,,Suspension of testis,A,,5.08,2.43,NA,2.43,,0.65,8.16,8.16,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,31954640,,Orchiopexy ingun/scrot appr,A,,7.54,3.20,NA,3.20,,1.05,11.79,11.79,0,090,0.10,0.80,0.10,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014