No office rate
54800 represents tissue sampling for diagnosis; 54830 is for excision of a defined epididymal lesion.
On this page
CMS RVU26D · Effective 2026-10-01
54800 Epididymal biopsy Medicare reimbursement rates in Washington
A surgeon samples epididymal tissue for histopathologic evaluation when a focal abnormality requires tissue diagnosis rather than lesion excision or epididymis removal. Compare 54800 office and facility rates across CMS payment localities in Washington.
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 54800 in Washington?
Washington 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
$111.36–$119.22
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.
Urology procedure
About 54800: Epididymal tissue biopsy
A surgeon samples epididymal tissue for histopathologic evaluation when a focal abnormality requires tissue diagnosis rather than lesion excision or epididymis removal.
A urologist obtains a tissue sample from the epididymis for pathologic examination, commonly to evaluate an abnormal area that requires a tissue diagnosis. The service involves sampling epididymal tissue; it is distinct from removing a defined lesion, excising a spermatocele, or removing the epididymis. It may be performed in an operating room or an ambulatory surgical setting.
Report 54800 when the documented service is an epididymal biopsy, and retain the operative note describing the sampled site, laterality, clinical indication, and tissue submitted for examination. The code has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. For bilateral biopsy, modifier 50 is paid at 150%. An assistant is paid only when medical necessity is documented; co-surgeons and team surgery are not permitted.
CMS billing rules for 54800
- 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 RVU2.27 · 68%
- Practice expense (office) RVU0.78 · 23%
- Malpractice RVU0.28 · 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.
54800 compared with similar codes
Office rates for Washington, from the same CMS release.
No office rate
Choose 54840 for spermatocele excision, with or without epididymectomy; 54800 describes a biopsy rather than removal of the spermatocele.
No office rate
54860 is unilateral removal of the epididymis. Use 54800 when the service is limited to obtaining tissue for diagnosis.
No office rate
54865 describes epididymal exploration and includes the possibility of biopsy. Do not separately report 54800 for biopsy work included in the exploration.
Compare 54800 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
Rest Of Washington →
Office / nonfacility
Unavailable
Facility
$111.36
Seattle (King Cnty) →
Office / nonfacility
Unavailable
Facility
$119.22
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54800 billing questions
How is 54800 different from excision of an epididymal lesion?
Use 54800 when tissue is sampled for diagnosis. When the surgeon removes a defined lesion, consider 54830 instead.
Can 54800 be reported with epididymal exploration?
54865 includes exploration with or without biopsy. Do not separately report 54800 for biopsy work included in that exploration.
How should bilateral biopsies be reported?
Report modifier 50 when the biopsy is performed bilaterally. CMS pays the bilateral service at 150%; document the sampled sites on both sides.
What documentation supports 54800?
The operative note should identify the epididymal site sampled, laterality, reason for biopsy, and tissue submitted for pathologic examination.
Can an assistant surgeon be paid for this procedure?
Assistant-at-surgery payment is available only when the record supports medical necessity. Co-surgeons and team surgery 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.
6,32554692,,Laparoscopy orchiopexy,A,,13.40,5.26,NA,5.26,,1.72,20.38,20.38,0,090,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,32654699,,Unlisted laps px testis,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,1,2,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
6,32754700,,I&d epdidyms tstis&/scrot sp,A,,3.38,2.13,NA,2.13,,0.48,5.99,5.99,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,32854800,,Biopsy of epididymis,A,,2.27,0.78,NA,0.78,,0.28,3.33,3.33,0,000,0.00,0.00,0.00,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,32954830,,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