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See a sample rate comparisonCPT 54500 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Biopsy Testis Needle
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Male Genital System |
| Common Place of Service | 11 - Office 24 - Ambulatory Surgical Center |
| Common Modifiers | None RT - Right side of body SG - Scene to Hospital ESRD facility |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 54500 |
| Medicaid Fee Schedule | View Medicaid rates for 54500 |
National average reimbursement for CPT 54500 by major payers:
$107.85
$103.86
$111.06
$129.94
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CPT 54500
5 of 25 sample ratesHigher to lower in this preview
South Campus Surgery Center
$3,994.00Published rateMedstar Surgery Center At Lafayette Centre, LLC
Medstar Surgery Center At Lafayette Centre LLC
$1,316.00Published rateEast Columbus Surgery Center LLC
$975.00Published ratePhysicians' Surgery Center Of Downey, LLC
Physicians Surgery Center Of
$443.00Published rateVision Correction Center, LLC
Vision Correction Center LLC
$288.00Published rate
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See a sample payer proposalCPT 54500 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54500 code is part of the Surgery services used for Surgical Procedures on the Male Genital System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 54500 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 54500-CPT | Low | Biopsy Testis Needle |
| 54505-CPT | Moderate | Biopsy Testis Incisional Unilat |
| 54512-CPT | Moderate | Excision Of Extraparenchymal Lesion Of Testis |
| 54520-CPT | Moderate | Remove All Or Part Of Testicle, Surgery To Remove An Entire Testicle Or Part Of One (Orchiectomy). If Infection Or Injury Is Present It Is Treated. Any Tumor Or Abnormal Tissue Is Removed. The Procedure May Include Placement Of An Artificial Testicle. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 54500. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54500 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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