Billing code 54560: Testicular explorationMedicare rate & RVUs in Nebraska
Reports operative inspection of a testis to investigate a suspected abnormality, whether or not the surgeon takes a biopsy during the exploration.
CMS doesn’t publish an office rate for 54560 in Nebraska.
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 54560 covers
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.
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 in Nebraska
| Payment locality | Office | Facility |
|---|---|---|
| Nebraska | Unavailable | $578.31 |
How the 54560 rate is calculated
Each of 54560’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 · 54560
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 11.80Practice expense 5.36Malpractice 1.50
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 54560
54560 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 54560
Testicular exploration
| 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| 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 · 54560
Testicular exploration
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 50 · payment effect
With and without the modifier
54560 without 50 · national facility
$623.26
Testicular exploration
54560-50 · Bilateral: 150%
$934.89
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
54560 compared with similar codes
Compare codes
54560 vs 54500 vs 54505 vs 54550 vs 54512: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 54500Testicular biopsy
- 54500 describes needle biopsy of the testis. Use 54560 when the surgeon performs operative exploration, with or without biopsy.
- 54505Testicular biopsy
- 54505 describes an incisional testicular biopsy. Choose 54560 when the service is testicular exploration rather than biopsy alone.
- 54550Testis exploration
- 54550 is for exploration of an undescended testis. 54560 is used for exploration of a testis for another suspected abnormality.
- 54512Testicular surgery
- 54512 is for excision of a testicular lesion. Use 54560 when the operative service is exploration, not removal of a lesion.
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 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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