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See a sample rate comparisonCPT 54865 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.
Exploratory Genital Surgery, Exploratory Surgery Of The Epididymis At The Back Of The Testicle. The Procedure May Take A Sample Of Tissue For Testing (Biopsy). 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 59 - Distinct Procedural Service RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 54865 |
| Medicaid Fee Schedule | View Medicaid rates for 54865 |
National average reimbursement for CPT 54865 by major payers:
$480.62
$475.71
$495.20
$601.00
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CPT 54865
5 of 25 sample ratesHigher to lower in this preview
Medical City Surgery Center Of Allen, LLC
$3,871.00Published rateMonterey Bay Endoscopy Center LLC
$2,240.00Published rateOrange City Surgical LLC, Adventhealth Surgery Center Blue Springs
Orange City Surgical, LLC
$1,884.00Published rateSan Antonio Eye Center, PA, San Antonio Eye Surgicenter
San Antonio Eye Center, PA
$1,121.00Published rateTriad Surgery Center LLC, Triad Eye Medical Clinic And Cataract Institute PLLC
Triad Eye Institute, PLLC
$640.00Published rate
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See a sample payer proposalCPT 54865 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54865 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 54865 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 |
|---|---|---|
| 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. |
| 54865-CPT | Moderate | Exploratory Genital Surgery, Exploratory Surgery Of The Epididymis At The Back Of The Testicle. The Procedure May Take A Sample Of Tissue For Testing (Biopsy). 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 54865. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54865 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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