No office rate
54500 is for needle biopsy sampling. Use 54512 when the surgeon excises the lesion itself.
On this page
CMS RVU26D · Effective 2026-10-01
54512 Testicular surgery Medicare reimbursement rates in Missouri
Surgical removal of a discrete testicular lesion, reported when the surgeon excises the lesion rather than sampling it or removing the testis. Compare 54512 office and facility rates across CMS payment localities in Missouri.
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 54512 in Missouri?
Missouri has 3 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 3 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$469.06–$483.37
3 of 3 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 54512 pays more and less in Missouri
Urology surgery
About 54512: Testicular lesion excision
Surgical removal of a discrete testicular lesion, reported when the surgeon excises the lesion rather than sampling it or removing the testis.
A urologist uses this service to surgically remove a localized lesion within the testis, such as a mass requiring excision for diagnosis or treatment. The operation is generally performed in an operative facility, and the excised tissue is submitted for examination. This service is distinct from taking a biopsy sample and from removing part or all of the testis.
Select the code when the operative report supports excision of a testicular lesion; document the lesion, laterality, procedure performed, and the tissue removed. Medicare includes the day-before preoperative visit and 90 days of related postoperative care in the 90-day global period. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. Medicare does not pay an assistant at surgery; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 54512
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU9.10 · 62%
- Practice expense (office) RVU4.39 · 30%
- Malpractice RVU1.19 · 8%
238
Medicare services in 2024 · #4174 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.
54512 compared with similar codes
Office rates for Missouri, from the same CMS release.
No office rate
54505 describes incisional biopsy, which obtains tissue for examination. 54512 represents excision of the lesion rather than a sample.
No office rate
54522 applies when part of the testis is removed. 54512 applies to excision of a discrete lesion without coding the service as partial orchiectomy.
No office rate
54530 describes radical orchiectomy for tumor. Use 54512 when the operation excises a lesion rather than removing the testis by radical orchiectomy.
Compare 54512 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.
3 of 3 payment localities
Metropolitan Kansas City →
Office / nonfacility
Unavailable
Facility
$480.47
Metropolitan St. Louis →
Office / nonfacility
Unavailable
Facility
$483.37
Rest Of Missouri →
Office / nonfacility
Unavailable
Facility
$469.06
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54512 billing questions
How is lesion excision different from a testicular biopsy?
Report 54512 when the surgeon excises the lesion itself. A biopsy code describes obtaining a tissue sample rather than removing the lesion.
When would partial orchiectomy be a better fit?
Use 54522 when the documented operation removes part of the testis. Choose 54512 when the operative service is excision of a discrete lesion.
Does the 90-day global period include follow-up care?
Yes. The global period includes the day-before preoperative visit and 90 days of related postoperative care.
How is bilateral excision reported?
When the procedure is performed bilaterally, report modifier 50; Medicare pays the bilateral procedure at 150%.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeons are paid only when supporting documentation is present.
What happens when another procedure is performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple procedure reduction.
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.
6,30754450,,Preputial stretching,A,,1.09,0.91,,0.27,,0.15,2.15,1.51,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,30854500,,Biopsy of testis,A,,1.28,0.57,NA,0.57,,0.16,2.01,2.01,0,000,0.00,0.00,0.00,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,30954505,,Biopsy of testis,A,,3.41,1.94,NA,1.94,,0.43,5.78,5.78,0,010,0.10,0.80,0.10,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,31054512,,Excise lesion testis,A,,9.10,4.39,NA,4.39,,1.19,14.68,14.68,0,090,0.10,0.80,0.10,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,31154520,,Removal of testis,A,,5.17,3.25,NA,3.25,,0.73,9.15,9.15,0,090,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,31254522,,Orchiectomy partial,A,,9.99,4.74,NA,4.74,,1.29,16.02,16.02,0,090,0.10,0.80,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,31354530,,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