No office rate
54860 describes unilateral removal; use 54861 when both epididymides are removed.
On this page
CMS RVU26D · Effective 2026-10-01
54860 Epididymectomy Medicare reimbursement rates in Illinois
Report unilateral epididymectomy when a urologist surgically removes an epididymis, commonly to treat persistent symptomatic epididymal disease such as chronic epididymitis. Compare 54860 office and facility rates across CMS payment localities in Illinois.
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 54860 in Illinois?
Illinois has 4 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 4 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$392.85–$428.09
4 of 4 localities have a supported rate.
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.
Where 54860 pays more and less in Illinois
Urologic surgery
About 54860: Unilateral epididymis removal
Report unilateral epididymectomy when a urologist surgically removes an epididymis, commonly to treat persistent symptomatic epididymal disease such as chronic epididymitis.
A urologist removes the epididymis through a scrotal operation, generally in a surgical facility. The procedure may be performed for persistent symptomatic epididymal disease, including chronic epididymitis causing ongoing pain despite treatment. This code represents removal of one epididymis, not sampling or excision of only a focal lesion.
Document the indication, side, and operative work showing that the epididymis was removed. For bilateral removal, report the bilateral code 54861 rather than appending modifier 50 to 54860. Medicare assigns a 90-day global period, which includes 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. Medicare does not pay an assistant at surgery for this code; co-surgeons and team surgery are not permitted.
CMS billing rules for 54860
- 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 adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU6.78 · 58%
- Practice expense (office) RVU3.95 · 34%
- Malpractice RVU0.88 · 8%
381
Medicare services in 2024 · #3778 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.
54860 compared with similar codes
Office rates for Illinois, from the same CMS release.
No office rate
54830 is for removal of a focal epididymal lesion. Use 54860 when the operation removes the unilateral epididymis.
No office rate
54840 is directed to spermatocele excision. Choose 54860 when the documented operation removes the epididymis rather than treating only the spermatocele.
No office rate
54800 represents biopsy for tissue sampling; 54860 represents surgical removal of the unilateral epididymis.
Compare 54860 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.
4 of 4 payment localities
Chicago →
Office / nonfacility
Unavailable
Facility
$428.09
East St. Louis →
Office / nonfacility
Unavailable
Facility
$407.03
Rest Of Illinois →
Office / nonfacility
Unavailable
Facility
$392.85
Suburban Chicago →
Office / nonfacility
Unavailable
Facility
$415.62
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54860 billing questions
When should 54860 be chosen instead of a lesion-excision code?
Use 54860 when the operation removes the unilateral epididymis. A procedure limited to a focal epididymal lesion is represented by a lesion-excision code.
How is bilateral epididymectomy reported?
Use 54861 for bilateral removal rather than reporting 54860 with modifier 50.
Does the 90-day global include related postoperative care?
Yes. The global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon or co-surgeon be billed?
Medicare does not pay an assistant at surgery for 54860. Co-surgeons and team surgery are not permitted.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures in that session are subject to the standard multiple-procedure reduction.
What documentation supports reporting 54860?
Document the condition prompting surgery, the side treated, and operative findings and work confirming removal of the epididymis rather than biopsy or focal lesion excision.
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.
6,32854800,,Biopsy of epididymis,A,,2.27,0.78,NA,0.78,,0.28,3.33,3.33,0,000,0.00,0.00,0.00,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,32954830,,Remove epididymis lesion,A,,5.86,3.77,NA,3.77,,0.78,10.41,10.41,0,090,0.10,0.80,0.10,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,33054840,,Remove epididymis lesion,A,,5.14,3.14,NA,3.14,,0.66,8.94,8.94,0,090,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,33154860,,Removal of epididymis,A,,6.78,3.95,NA,3.95,,0.88,11.61,11.61,0,090,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,33254861,,Removal of epididymis,A,,9.46,4.89,NA,4.89,,1.22,15.57,15.57,0,090,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,33354865,,Explore epididymis,A,,5.63,3.71,NA,3.71,,0.72,10.06,10.06,0,090,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,33454900,,Fusion of spermatic ducts,A,,13.85,6.08,NA,6.08,,1.77,21.70,21.70,0,090,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00