No office rate
54860 is the unilateral procedure. Use 54861 when both epididymides are removed; do not report modifier 50 with 54861.
On this page
CMS RVU26D · Effective 2026-10-01
54861 Epididymectomy Medicare reimbursement rates in Tennessee
Reported for operative removal of both epididymides when bilateral disease or symptoms require definitive surgical treatment rather than unilateral excision or focal lesion removal. Compare 54861 office and facility rates across CMS payment localities in Tennessee.
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 54861 in Tennessee?
Tennessee has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$486.32
1 of 1 localities have a supported rate.
Payment area: Tennessee
One mapped payment locality.
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.
Urology surgery
About 54861: Bilateral epididymectomy
Reported for operative removal of both epididymides when bilateral disease or symptoms require definitive surgical treatment rather than unilateral excision or focal lesion removal.
A urologist removes the epididymis on each side during an operation, generally in a facility setting. The procedure may be considered when both sides have disease or persistent symptoms requiring surgical treatment; it is more extensive than removing a localized cyst or other lesion. The operative report should establish that both epididymides were removed and describe the bilateral indication and procedure performed.
Report the bilateral service once; modifier 50 is inappropriate. When other procedures are performed in the same session, CMS applies the standard multiple procedure reduction: the highest-valued procedure is paid in full and the others at 50%. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. Assistant-at-surgery payment requires documented medical necessity. CMS does not permit co-surgeons or team surgery for this code.
CMS billing rules for 54861
- 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 adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU9.46 · 61%
- Practice expense (office) RVU4.89 · 31%
- Malpractice RVU1.22 · 8%
28
Medicare services in 2024 · #5711 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.
54861 compared with similar codes
Office rates for Tennessee, from the same CMS release.
No office rate
54830 addresses removal of a localized epididymal lesion. 54861 represents removal of both epididymides, not just a focal abnormality.
No office rate
54840 is directed to a spermatocele. Choose 54861 only when the operation removes both epididymides rather than treating the spermatocele alone.
No office rate
54865 describes exploration of the epididymis. It does not represent the bilateral removal performed under 54861.
Compare 54861 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.
1 of 1 payment localities
Tennessee →
Office / nonfacility
Unavailable
Facility
$486.32
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 54861 in Tennessee.
PPRRVU2026_Oct_nonQPP.csv
6,332
- Code
- 54861
- Physician work
- 9.46
- Practice expense
- 4.89
- Malpractice
- 1.22
GPCI2026.csv
95
- Locality
- Tennessee
- Physician work
- 1.000
- Practice expense
- 0.909
- Malpractice
- 0.537
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 9.46 | × 1.000 | 9.4600 |
| Practice expense | 4.89 | × 0.909 | 4.4450 |
| Malpractice | 1.22 | × 0.537 | 0.6551 |
| Total RVUs | 14.5602 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Tennessee$486.32
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 9.46 | 1 |
| Practice expense | 4.89 | 0.909 |
| Malpractice | 1.22 | 0.537 |
(9.46 × 1 + 4.89 × 0.909 + 1.22 × 0.537) × $33.4009 = $486.32
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
54861 billing questions
How does this differ from 54860?
54861 describes removal on both sides; 54860 is the unilateral service. Document the side or sides treated in the operative report.
Should modifier 50 be appended?
No. The bilateral service is represented by this code, and CMS identifies modifier 50 as inappropriate.
Can a localized epididymal lesion be coded with this procedure?
A focused removal of an epididymal lesion or spermatocele is distinct from removing both epididymides. The operative report should support the actual extent of surgery.
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.
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.
6,32954830,,Remove epididymis lesion,A,,5.86,3.77,NA,3.77,,0.78,10.41,10.41,0,090,0.10,0.80,0.10,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,33054840,,Remove epididymis lesion,A,,5.14,3.14,NA,3.14,,0.66,8.94,8.94,0,090,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,33154860,,Removal of epididymis,A,,6.78,3.95,NA,3.95,,0.88,11.61,11.61,0,090,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,33254861,,Removal of epididymis,A,,9.46,4.89,NA,4.89,,1.22,15.57,15.57,0,090,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,33354865,,Explore epididymis,A,,5.63,3.71,NA,3.71,,0.72,10.06,10.06,0,090,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,33454900,,Fusion of spermatic ducts,A,,13.85,6.08,NA,6.08,,1.77,21.70,21.70,0,090,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,33554901,,Fusion of spermatic ducts,A,,18.62,7.46,NA,7.46,,2.40,28.48,28.48,0,090,0.10,0.80,0.10,2,2,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537
9604412,TX,31,AUSTIN,1.002,1.058,0.886
9704412,TX,20,BEAUMONT,1.000,0.910,0.929
9804412,TX,09,BRAZORIA,1.008,0.991,0.780