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See a sample rate comparisonCPT 54861 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 KX - Requirements specified in the medical policy have been met 50 - Bilateral Procedure |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 54861 |
| Medicaid Fee Schedule | View Medicaid rates for 54861 |
National average reimbursement for CPT 54861 by major payers:
$705.72
$754.25
$778.65
$927.95
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CPT 54861
5 of 25 sample ratesHigher to lower in this preview
Canonsburg General Hospital
Highmark Health
$9,198.95Published ratePrince William Ambulatory Surgery Center, LLC, Prince William Surgery Center
Prince William Ambulatory
$2,307.00Published rateWills Eye Surgery Center
Wilmington Ambulatory Surgical Center LLC
$1,485.00Published rateTriad Surgery Center, LLC, Triad Eye Institute
$1,026.00Published rateDoctors Surgery Center, PA
Doctors Surgery Center PA
$638.00Published rate
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See a sample payer proposalCPT 54861 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54861 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 54861 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. |
| 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 54861. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54861 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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