No office rate
54865 describes operative assessment of epididymal anatomy; 54800 is selected when the purpose is obtaining epididymal tissue for biopsy.
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CMS RVU26D · Effective 2026-10-01
54865 Epididymal exploration Medicare reimbursement rates in Texas
Urologists report operative exploration of the epididymis when suspected obstruction or another structural abnormality requires direct surgical assessment. Compare 54865 office and facility rates across CMS payment localities in Texas.
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 54865 in Texas?
Texas has 8 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 8 payment areas shown below, using the same CMS release.
Office / nonfacility
No 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 54865 pays more and less in Texas
Urology surgery
About 54865: Operative epididymal exploration
Urologists report operative exploration of the epididymis when suspected obstruction or another structural abnormality requires direct surgical assessment.
A urologist surgically examines the epididymis, the coiled structure alongside the testis, to assess a suspected abnormality that requires direct operative evaluation. One clinical setting is male infertility evaluation when an epididymal blockage is suspected. The service is performed in an operative setting; it is distinct from taking tissue solely for biopsy or removing a defined lesion or the epididymis itself.
Report the exploration when the operative work is directed at assessing epididymal anatomy, and document the indication, side, surgical approach, and findings. CMS assigns a 90-day major-surgery global period, including the day-before preoperative visit and related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 54865
- 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 RVU5.63 · 56%
- Practice expense (office) RVU3.71 · 37%
- Malpractice RVU0.72 · 7%
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.
54865 compared with similar codes
Office rates for Texas, from the same CMS release.
No office rate
Choose 54865 for exploration without removal of a defined lesion. Choose 54830 when the operative service is excision of an epididymal lesion.
No office rate
54865 is exploration; 54840 is used when a spermatocele is surgically removed.
No office rate
Exploration assesses the epididymis; 54860 reports its removal. Do not substitute removal when the documented service is exploration.
Compare 54865 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.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Office Unavailable | Facility $340.83 |
| Beaumont | Office Unavailable | Facility $323.15 |
| Brazoria | Office Unavailable | Facility $331.11 |
| Dallas | Office Unavailable | Facility $333.79 |
| Fort Worth | Office Unavailable | Facility $332.87 |
| Galveston | Office Unavailable | Facility $332.51 |
| Houston | Office Unavailable | Facility $345.69 |
| Rest Of Texas | Office Unavailable | Facility $327.36 |
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54865 billing questions
When should 54865 be chosen instead of an epididymal biopsy?
Use 54865 when the operative service is exploration to assess epididymal anatomy, such as suspected obstruction. Use 54800 when the service is biopsy for tissue sampling.
Can a biopsy or lesion removal be separately reported during the exploration?
The operative report should identify any distinct sampling or treatment performed in addition to exploration. Apply the same-session multiple-procedure payment reduction when multiple procedures are reported.
Should modifier 50 be used when both epididymides are explored?
No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 should not be used.
What documentation supports reporting epididymal exploration?
Document the clinical reason for direct exploration, the side and structures assessed, and the operative findings. The note should make clear that the service was exploration rather than biopsy or removal.
Can an assistant surgeon be reported?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeon and team-surgery payment 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.
6,33054840,,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
6,33655000,,Drainage of hydrocele,A,,1.39,2.21,,0.74,,0.18,3.78,2.31,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00