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See a sample rate comparisonCPT 54505 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 Incisional Unilat
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Male Genital System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None RT - Right side of body LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 54505 |
| Medicaid Fee Schedule | View Medicaid rates for 54505 |
National average reimbursement for CPT 54505 by major payers:
$291.21
$282.51
$300.42
$346.10
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CPT 54505
5 of 25 sample ratesHigher to lower in this preview
Memorial Hermann Endoscopy & Surgery Center North Houston, LLC, North Houston Endoscopy & Surgery Center
$5,729.00Published rateSf Nassau Asc LLC
$1,821.00Published rateSalem Endoscopy Center, LLC
Salem Endoscopy Center LLC
$1,155.00Published rateBelleair Surgery Center Ltd
$1,062.00Published rateCampus Surgery Center LLC
Campus Surgery Center L P
$496.00Published rate
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See a sample payer proposalCPT 54505 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54505 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 54505 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 54505. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54505 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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