No office rate
Use 54535 for the abdominal approach to radical tumor removal. Use 54530 when the radical operation is performed through the inguinal approach.
On this page
CMS RVU26D · Effective 2026-10-01
54535 Radical orchiectomy Medicare reimbursement rates in New York
Reports radical removal of a testis for tumor through an abdominal approach, including situations in which the affected testis is located intra-abdominally. Compare 54535 office and facility rates across CMS payment localities in New York.
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 54535 in New York?
New York has 5 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 5 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$647.88–$784.15
5 of 5 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 54535 pays more and less in New York
Urologic surgery
About 54535: Radical orchiectomy by abdominal approach
Reports radical removal of a testis for tumor through an abdominal approach, including situations in which the affected testis is located intra-abdominally.
A urologist performs this operation to remove a testis for a tumor through an abdominal approach, with dissection of the associated spermatic cord. It may be used when the affected testis is intra-abdominal. The operation is performed in an operating room and is more extensive than removing a localized testicular lesion or only part of the testis.
Choose this code based on the operative indication, the radical extent of removal, and the abdominal route documented in the operative report. The code has a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeons and team surgery are not permitted.
CMS billing rules for 54535
- 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 not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU12.86 · 64%
- Practice expense (office) RVU5.66 · 28%
- Malpractice RVU1.65 · 8%
21
Medicare services in 2024 · #5901 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.
54535 compared with similar codes
Office rates for New York, from the same CMS release.
No office rate
This code describes radical tumor surgery by an abdominal approach; 54520 describes simple orchiectomy, not radical removal for tumor.
No office rate
Use 54522 when only part of the testis is removed. Use 54535 when the operation is radical removal for tumor through the abdominal approach.
No office rate
54512 is for excision of a testicular lesion. Choose 54535 when the documented operation is radical removal for tumor through an abdominal approach.
Compare 54535 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.
5 of 5 payment localities
Manhattan →
Office / nonfacility
Unavailable
Facility
$764.11
Nyc Suburbs/Long Island →
Office / nonfacility
Unavailable
Facility
$784.15
Poughkpsie/N Nyc Suburbs →
Office / nonfacility
Unavailable
Facility
$722.56
Queens →
Office / nonfacility
Unavailable
Facility
$759.95
Rest Of New York →
Office / nonfacility
Unavailable
Facility
$647.88
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
54535 billing questions
How is this different from 54530?
Both describe radical removal for a testicular tumor. This code is for the abdominal approach; 54530 is for the inguinal approach.
When would a limited testicular excision be a better fit?
Use a limited excision code when the operation removes a localized lesion rather than the testis radically. The operative report should establish the extent of tissue removed.
What does the 90-day global period include?
It includes the day-before preoperative visit and 90 days of related postoperative care.
How is bilateral surgery reported?
CMS lists bilateral reporting with modifier 50, paid at 150%.
Can an assistant or another surgeon be reported?
An assistant at surgery may be paid. Co-surgeons and team surgery are not permitted for this code.
What should the operative report support?
Document the tumor indication, abdominal approach, and radical extent of removal, including the side operated on.
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.
6,31154520,,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
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