Billing code 54830: Epididymal lesionMedicare rate & RVUs in Rhode Island
Reports surgical removal of a localized epididymal lesion when the surgeon excises the abnormal tissue rather than taking a diagnostic sample or removing the entire epididymis.
CMS doesn’t publish an office rate for 54830 in Rhode Island.
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 54830 covers
A urologist uses this service to remove a localized abnormality arising in the epididymis, the coiled structure alongside the testicle. The procedure is typically performed in an operating room, often for a palpable or imaging-identified mass requiring excision. The surgeon removes the lesion while retaining the remaining epididymis when feasible; the tissue may be submitted for pathologic examination. A spermatocele has its own procedure code, so the specific lesion being treated matters when selecting the service.
Report this code when the operative record supports excision of a localized epididymal lesion, not biopsy alone or removal of the whole epididymis. Document the lesion, operative findings, and what tissue was removed. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For same-session procedures, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. An assistant at surgery is paid only when medical necessity is documented; 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.
54830 in Rhode Island
| Payment locality | Office | Facility |
|---|---|---|
| Rhode Island | Unavailable | $352.76 |
How the 54830 rate is calculated
Each of 54830’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 · 54830
RVUs × geographic indexes × conversion factor
Work5.86
5.86 RVUs× 1.000 GPCI
Practice expense3.77
3.77 RVUs× 1.000 GPCI
Malpractice0.78
0.78 RVUs× 1.000 GPCI
Adjusted RVUs
10.4100
Conversion factor
$33.4009
Medicare rate
$347.70
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 54830
54830 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 54830
Epididymal lesion
| 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) | 0 | Not paid without supporting documentation. |
| 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 · 54830
Epididymal lesion
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
54830 without 50 · national facility
$347.70
Epididymal lesion
54830-50 · Bilateral: 150%
$521.55
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).
54830 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 54800Epididymal biopsy
- 54800 is for obtaining a diagnostic epididymal tissue sample. Choose 54830 when the surgeon removes a localized lesion rather than sampling it.
- 54840Spermatocele removal
- 54840 is the specific code for spermatocele excision. 54830 applies to excision of a different localized epididymal lesion.
- 54860Epididymectomy
- 54860 describes removal of the entire epididymis on one side. 54830 is for excision of a localized lesion while retaining the remaining epididymis.
- 54865Epididymal exploration
- 54865 describes surgical exploration of the epididymis. Use 54830 when the operative service includes excision of a localized lesion.
54830 billing questions
How does this differ from an epididymal biopsy?
Use 54830 when the surgeon excises the localized lesion. Code 54800 describes sampling epididymal tissue for diagnosis rather than removing the lesion.
Is a spermatocele reported with this code?
A spermatocele has a distinct excision code, 54840. Select based on the condition and procedure documented, rather than treating every epididymal cystic lesion as the same service.
Can this code be reported for bilateral lesions?
CMS identifies this as a bilateral procedure; bilateral reporting with modifier 50 is paid at 150%. The operative documentation should support treatment on both sides.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
When is an assistant at surgery payable?
CMS allows assistant-at-surgery payment only when medical necessity is documented. Co-surgeons and team surgery are not permitted for this code.
What happens when another procedure is performed in the same session?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
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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