No office rate
Choose 54500 for percutaneous needle sampling. Choose 54505 when the biopsy is obtained through an incision.
On this page
CMS RVU26D · Effective 2026-10-01
54500 Testicular biopsy Medicare reimbursement rates in Utah
Reports needle sampling of testicular tissue through the scrotal skin, typically for diagnostic evaluation when a percutaneous biopsy approach is performed. Compare 54500 office and facility rates across CMS payment localities in Utah.
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 54500 in Utah?
Utah 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
$65.45
1 of 1 localities have a supported rate.
Payment area: Utah
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 procedure
About 54500: Percutaneous testicular needle biopsy
Reports needle sampling of testicular tissue through the scrotal skin, typically for diagnostic evaluation when a percutaneous biopsy approach is performed.
A urologist obtains a small sample of testicular tissue by passing a needle through the scrotal skin. The procedure may be performed in an office or facility setting when tissue sampling is needed for diagnostic evaluation, including selected infertility or suspected testicular disease workups. The route matters: this code describes needle sampling, not an incisional biopsy or excision of a testicular lesion.
Report the service when the record supports the indication, percutaneous needle approach, testis sampled, and tissue obtained. Same-day preoperative and postoperative care is included in the 0-day global period. For bilateral performance, modifier 50 is paid at 150%. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and the others at 50%. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 54500
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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 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 RVU1.28 · 64%
- Practice expense (office) RVU0.57 · 28%
- Malpractice RVU0.16 · 8%
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.
54500 compared with similar codes
Office rates for Utah, from the same CMS release.
No office rate
54512 describes excising a testicular lesion. This code describes diagnostic tissue sampling with a needle, not lesion removal.
No office rate
54522 describes partial removal of a testis. Use this code for needle biopsy when tissue sampling, rather than partial organ removal, is performed.
Compare 54500 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
Utah →
Office / nonfacility
Unavailable
Facility
$65.45
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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 54500 in Utah.
PPRRVU2026_Oct_nonQPP.csv
6,308
- Code
- 54500
- Physician work
- 1.28
- Practice expense
- 0.57
- Malpractice
- 0.16
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.28 | × 1.000 | 1.2800 |
| Practice expense | 0.57 | × 0.940 | 0.5358 |
| Malpractice | 0.16 | × 0.898 | 0.1437 |
| Total RVUs | 1.9595 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Utah$65.45
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.28 | 1 |
| Practice expense | 0.57 | 0.94 |
| Malpractice | 0.16 | 0.898 |
(1.28 × 1 + 0.57 × 0.94 + 0.16 × 0.898) × $33.4009 = $65.45
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.
54500 billing questions
How does this differ from 54505?
54500 is for needle sampling through the scrotal skin. Use 54505 when the testicular biopsy is performed through an incision.
Can pathology be reported with the biopsy?
A pathology examination may be reported for the submitted tissue when that examination is performed and documented. The biopsy service describes obtaining the specimen; pathology describes its examination.
How is bilateral performance reported?
When the service is performed on both testes, report modifier 50; CMS pays the bilateral procedure at 150%.
What care is included in the global period?
The 0-day global period includes same-day preoperative and postoperative care.
Can an assistant or co-surgeon be billed?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeon and team-surgery billing are 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 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.
6,30554437,,Repair corporeal tear,A,,11.21,5.90,NA,5.90,,1.44,18.55,18.55,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,30654440,,Repair of penis,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,30754450,,Preputial stretching,A,,1.09,0.91,,0.27,,0.15,2.15,1.51,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,30854500,,Biopsy of testis,A,,1.28,0.57,NA,0.57,,0.16,2.01,2.01,0,000,0.00,0.00,0.00,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,30954505,,Biopsy of testis,A,,3.41,1.94,NA,1.94,,0.43,5.78,5.78,0,010,0.10,0.80,0.10,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,31054512,,Excise lesion testis,A,,9.10,4.39,NA,4.39,,1.19,14.68,14.68,0,090,0.10,0.80,0.10,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
10104412,TX,15,GALVESTON,1.008,0.993,0.828
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985