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See a sample rate comparisonHealthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Male Genital System |
| Common Place of Service | 22 - On Campus Outpatient Hospital |
| Common Modifiers | None RT - Right side of body 50 - Bilateral Procedure |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 54699 |
| Medicaid Fee Schedule | View Medicaid rates for 54699 |
National average reimbursement for CPT 54699 by major payers:

$1,225.56

$176.64

$1,890.24

$1,186.62
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Rate Benchmarking
Select a published rate, define comparable providers, and see where that rate falls in your market.
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Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 54699 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54699 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 54699 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 |
|---|---|---|
| 54680-CPT | Moderate | Transplnt Of Testis(Es) To Thigh (Because Of Scrotal Destruct, Transplantation Of Testis(Es) To Thigh (Because Of Scrotal Destruction |
| 54690-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. |
| 54692-CPT | High | Laparoscopy, Surgical; Orchiopexy For Intra-Abdominal Testis |
| 54699-CPT | High | Unlisted Laparoscopy Procedure, Testis |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 54699. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54699 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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