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See a sample rate comparisonCPT 54860 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.
Remove Epididymis (Sperm Tube), Surgery To Remove One Or Both Tubes From The Back Of The Testicles (Epididymis). The Epididymis Stores And Transports Sperm.
| 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 LT - Left side of body RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 54860 |
| Medicaid Fee Schedule | View Medicaid rates for 54860 |
National average reimbursement for CPT 54860 by major payers:
$542.75
$556.25
$586.01
$686.42
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CPT 54860
5 of 25 sample ratesHigher to lower in this preview
Mclean Ambulatory Surgery, LLC
Mclean Ambulatory Surgery LLC
$4,623.00Published rateTheda Oaks Gastroenterology & Endoscopy Center, LLC
Theda Oaks Gastroenterology & Endoscopy Ctr, Ltd
$2,859.00Published rateSan Joaquin Laser Surgery Center
$1,557.00Published rateMadison Surgery Center, LLC
Madison Surgery Center, L.L.C.
$1,000.00Published rateKearny Robert
Lmg, LLC
$451.38Published rate
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See a sample payer proposalCPT 54860 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54860 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 54860 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 |
|---|---|---|
| 54700-CPT | Moderate | Drainage Of Genital Injury, Procedure To Drain A Deep Abscess Or Hematoma (Pocket Of Infection Or Blood) From The Penis Scrotum Testicles Or Other Part Of The Genitals. |
| 54800-CPT | Low | Sperm Storage Tube Biopsy, A Procedure To Remove A Sample Of Tissue For Testing (Biopsy) From The Epididymis (At The Back Of The Testicles). The Epididymis Stores And Transports Sperm. |
| 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. |
| 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. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 54860. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54860 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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