Billing code 54860: EpididymectomyMedicare rate & RVUs in Iowa
Report unilateral epididymectomy when a urologist surgically removes an epididymis, commonly to treat persistent symptomatic epididymal disease such as chronic epididymitis.
CMS doesn’t publish an office rate for 54860 in Iowa.
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 54860 covers
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.
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 in Iowa
| Payment locality | Office | Facility |
|---|---|---|
| Iowa | Unavailable | $358.85 |
How the 54860 rate is calculated
Each of 54860’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 · 54860
RVUs × geographic indexes × conversion factor
Work6.78
6.78 RVUs× 1.000 GPCI
Practice expense3.95
3.95 RVUs× 1.000 GPCI
Malpractice0.88
0.88 RVUs× 1.000 GPCI
Adjusted RVUs
11.6100
Conversion factor
$33.4009
Medicare rate
$387.78
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 54860
54860 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 54860
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) | 1 | Not paid (statutory restriction). |
| 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 · 54860
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
54860 without 51 · national facility
$387.78
Epididymectomy
54860-51 · Second procedure: 50%
$193.89
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%).
54860 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 54861Epididymectomy
- 54860 describes unilateral removal; use 54861 when both epididymides are removed.
- 54830Epididymal lesion
- 54830 is for removal of a focal epididymal lesion. Use 54860 when the operation removes the unilateral epididymis.
- 54840Spermatocele removal
- 54840 is directed to spermatocele excision. Choose 54860 when the documented operation removes the epididymis rather than treating only the spermatocele.
- 54800Epididymal biopsy
- 54800 represents biopsy for tissue sampling; 54860 represents surgical removal of the unilateral epididymis.
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 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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