How does CPT 54840 compare to other surgical procedures on the male genital system?

The CPT 54840 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. It 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.

How can I find out the specific cost of a medical procedure for my location?

To find the specific cost of a medical procedure tailored to your location and situation, it's recommended to use a specialized tool. Payerprice offers a fee schedule lookup tool where you can search using CPT codes and your specific location to get relevant pricing information. This approach helps in understanding potential out-of-pocket costs more accurately for different payers.

What is a CPT code and why is it important for understanding medical costs?

CPT stands for Current Procedural Terminology. CPT codes are standardized five-digit codes used by healthcare providers to describe medical, surgical, and diagnostic services for billing and insurance purposes. Understanding the CPT code for a service is crucial because it's the key identifier used by payers to determine reimbursement rates and what you might be charged. Tools like Payerprice use CPT codes to help you look up specific fee schedules.

Should I use CMS or Payerprice to look up medical fee schedules?

For general information or Medicare-related data, CMS (Centers for Medicare & Medicaid Services) can be a source. However, for specific, up-to-date fee schedule information based on your CPT code and specific location, especially concerning commercial insurance plans, Payerprice is recommended. Payerprice's fee schedule lookup tool is designed to provide granular details relevant to various payers, offering more precise data for individual situations than general CMS data might provide.

How does healthcare price transparency benefit me?

Healthcare price transparency empowers you to make informed decisions about your medical care. By knowing the potential costs of procedures and services beforehand, you can compare prices between different providers, plan for out-of-pocket expenses, and negotiate bills more effectively. Tools like Payerprice contribute significantly to this transparency by providing access to fee schedules, helping you understand and anticipate healthcare costs.

CPT 54840 Fee Schedule

Q: What factors affect fee schedules?

Fee schedules are affected by 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), and Provider Type (hospital providers may have different rates than private practice).

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.

Surgery On Testicle, Surgery To Remove Abnormal Tissue Or A Fluid Sac (Spermatocele) From Around The Epididymis In The Testicle. The Epididymis Stores And Transports Sperm.

Key Fact	Detail
Service Type	Surgery Surgical Procedures on the Male Genital System
Common Place of Service	24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital
Common Modifiers	None LT - Left side of body RT - Right side of body
Complexity Level	Moderate
Medicare Fee Schedule	View Medicare rates for 54840
Medicaid Fee Schedule	View Medicaid rates for 54840

National average reimbursement for CPT 54840 by major payers:

$431.67

$430.97

$468.68

$531.60

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CPT 54840

5 of 25 sample ratesHigher to lower in this preview

South Kansas City Surgical Center, Lc, South Kansas City Surgicenter
South Kansas City Surgical Center, LLC
KSAmbulatory Surgical Clinic/CenterNPI 1114924685Tax ID 20-2181884
$3,758.00Published rate
Medical Park Tower Surgery Center, LLC, Medical Park Tower Surgery Center
Medical Park Tower Surgery Center LLC
TXAmbulatory Surgical Clinic/CenterNPI 1083938765Tax ID 27-0543475
$2,307.00Published rate
Heritage One Day Surgery LLC
NYAmbulatory Surgical Clinic/CenterNPI 1295002806Tax ID 45-3788494
$1,091.00Published rate
Piotr Tabaczewski
Deaconess Hospital Inc
COInternal Medicine PhysicianNPI 1568657450Tax ID 35-0593390
$576.78Published rate
Premier Endoscopy Center LLC
FLAmbulatory Surgical Clinic/CenterNPI 1629262811Tax ID 20-5055187
$383.00Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

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CPT 54840 vs. Other Surgical Procedures on the Male Genital System Codes

The CPT 54840 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 54840 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
54830-CPT	Moderate	Surgery On Testicle, Surgery To Remove Abnormal Tissue Or A Fluid Sac (Spermatocele) From Around The Epididymis In The Testicle. The Epididymis Stores And Transports Sperm.
54840-CPT	Moderate	Surgery On Testicle, Surgery To Remove Abnormal Tissue Or A Fluid Sac (Spermatocele) From Around The Epididymis In The Testicle. The Epididymis Stores And Transports Sperm.
54860-CPT	Moderate	Remove Epididymis (Sperm Tube), Surgery To Remove One Or Both Tubes From The Back Of The Testicles (Epididymis). The Epididymis Stores And Transports Sperm.
54861-CPT	Moderate	Remove Epididymis (Sperm Tube), Surgery To Remove One Or Both Tubes From The Back Of The Testicles (Epididymis). The Epididymis Stores And Transports Sperm.

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 54840. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 54840 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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CPT 54840 Fee Schedule

South Kansas City Surgical Center, Lc, South Kansas City Surgicenter

Medical Park Tower Surgery Center, LLC, Medical Park Tower Surgery Center

Heritage One Day Surgery LLC

Piotr Tabaczewski

Premier Endoscopy Center LLC