$241.79–$281.62
Choose 55100 when the procedure drains a scrotal abscess. Choose 55120 when the service removes a discrete scrotal lesion.
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CMS RVU26D · Effective 2026-10-01
55120 Scrotal lesion Medicare reimbursement rates in Virginia
Excision of a discrete scrotal lesion is reported when the procedure removes the lesion itself rather than draining an abscess or exploring the scrotum. Compare 55120 office and facility rates across CMS payment localities in Virginia.
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 55120 in Virginia?
Virginia has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$322.30–$365.66
2 of 2 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.
Urologic surgery
About 55120: Scrotal lesion excision
Excision of a discrete scrotal lesion is reported when the procedure removes the lesion itself rather than draining an abscess or exploring the scrotum.
55120 describes surgical removal of a localized lesion from the scrotum. The target is a discrete lesion, such as a scrotal cyst or other abnormal growth; the work is directed at removing that lesion, not draining an abscess or removing scrotal tissue broadly. Urologists and general surgeons perform the procedure, commonly in a facility operating room, when excision is the planned treatment or permits pathologic evaluation.
Report the service when the operative record supports excision of a scrotal lesion, identifying its site and nature, the extent of removal, and any specimen sent for pathology. The code carries a 90-day global period: the day-before preoperative visit and related postoperative care during that period are included. When multiple procedures occur in one session, Medicare pays the highest-valued procedure in full and reduces the others under the standard multiple-procedure rule. Modifier 50 is inappropriate. An assistant is payable only when medical necessity is documented; co-surgeons and team surgery are not permitted.
CMS billing rules for 55120
- 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 RVU5.58 · 56%
- Practice expense (office) RVU3.63 · 37%
- Malpractice RVU0.71 · 7%
45
Medicare services in 2024 · #5424 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.
55120 compared with similar codes
Office rates for Virginia, from the same CMS release.
55110
No office rateScrotal exploration
55110 represents exploration of the scrotum. 55120 is for excision of an identified lesion, not exploration alone.
No office rate
55150 involves removal of scrotal tissue more broadly; 55120 targets a localized lesion rather than the scrotum as a whole.
Compare 55120 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.
2 of 2 payment localities
Dc + Md/Va Suburbs →
Office / nonfacility
Unavailable
Facility
$365.66
Virginia →
Office / nonfacility
Unavailable
Facility
$322.30
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55120 billing questions
How is 55120 different from drainage of a scrotal abscess?
55120 represents removal of a discrete lesion. Drainage of an abscess is a different service directed at evacuating infected contents.
Can modifier 50 be used for lesions on both sides?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
What care is included in the global period?
The day-before preoperative visit and 90 days of related postoperative care are included in the 90-day global period.
Can an assistant surgeon be reported?
Assistant-at-surgery payment is available only when the record documents medical necessity. Co-surgeons and team surgery are not permitted.
What documentation supports reporting 55120?
Document the scrotal site, the lesion being removed, the extent of excision, and whether a specimen was sent for pathologic evaluation.
Is the pathology examination part of 55120?
55120 represents the surgeon’s removal of the lesion, not microscopic examination of the specimen. The pathology service is reported separately by the professional performing it when reportable.
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.
6,33955060,,Repair of hydrocele,A,,6.00,3.81,NA,3.81,,0.79,10.60,10.60,0,090,0.10,0.80,0.10,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,34055100,,Drainage of scrotum abscess,A,,2.39,4.66,,2.14,,0.38,7.43,4.91,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,34155110,,Explore scrotum,A,,6.17,3.84,NA,3.84,,0.86,10.87,10.87,0,090,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,34255120,,Removal of scrotum lesion,A,,5.58,3.63,NA,3.63,,0.71,9.92,9.92,0,090,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,34355150,,Removal of scrotum,A,,7.94,4.62,NA,4.62,,1.08,13.64,13.64,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,34455175,,Revision of scrotum,A,,5.72,3.70,NA,3.70,,0.75,10.17,10.17,0,090,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,34555180,,Revision of scrotum,A,,11.49,5.69,NA,5.69,,1.50,18.68,18.68,0,090,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00