Billing code 54505: Testicular biopsyMedicare rate & RVUs in Washington
Reports surgical sampling of testicular tissue through an incision, commonly for evaluating infertility or azoospermia when tissue architecture is needed.
CMS doesn’t publish an office rate for 54505 in Washington.
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 54505 covers
A urologist obtains a tissue sample from the testis through a surgical incision, generally with the patient in a procedural or operating-room setting. A typical indication is evaluating infertility or azoospermia when examination of testicular tissue can help assess spermatogenesis. The specimen is submitted for pathologic examination; the procedure code represents obtaining the tissue, not the pathologist’s interpretation.
Select this code for incisional tissue sampling, rather than percutaneous needle sampling. The operative note should identify the testis sampled, the incision and sampling performed, and the clinical reason. It has a 10-day global period, so related postoperative visits during that period are included. For bilateral procedures, modifier 50 is paid at 150%. When multiple procedures occur in one session, the highest-valued procedure is paid in full and others at 50%. 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.
Where 54505 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $194.54 |
| Seattle (King Cnty) | Unavailable | $210.83 |
How the 54505 rate is calculated
Each of 54505’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 · 54505
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 3.41Practice expense 1.94Malpractice 0.43
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 54505
54505 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 54505
Testicular biopsy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 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 · 54505
Testicular biopsy
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
54505 without 50 · national facility
$193.06
Testicular biopsy
54505-50 · Bilateral: 150%
$289.59
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).
54505 compared with similar codes
Compare codes
54505 vs 54500 vs 54512 vs 54522: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 54500Testicular biopsy
- Choose 54505 when tissue is obtained through an incision; choose 54500 for needle sampling.
- 54512Testicular surgery
- 54512 represents excision of a testicular lesion. This code represents incisional tissue sampling, not removal of a focal lesion.
- 54522Partial orchiectomy
- 54522 involves partial removal of the testis. Use 54505 when the service is tissue sampling rather than removal of a testicular portion.
54505 billing questions
How does this differ from 54500?
54505 is for tissue obtained through an incision. Use 54500 for needle sampling.
Can pathology be billed separately?
Yes. This code represents obtaining the testicular tissue; a separately performed pathologic examination is reported by the appropriate pathology service.
How is a bilateral biopsy reported?
When both testes are biopsied, report modifier 50; CMS pays the bilateral procedure at 150%.
Are postoperative visits separately payable during the global period?
Related postoperative visits during the 10-day global period are included in the procedure.
What documentation supports incisional sampling?
Document the indication, the testis sampled, and the surgical incision and tissue acquisition. The record should make clear that the method was incisional rather than needle sampling.
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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