Find policies, billing codes, payers, states, and providers

CPT 54500: Testicular Needle Biopsy, Diagnostic Tissue Sampling

CPT code 54500 denotes a testicular needle biopsy — a diagnostic procedure in which a provider obtains tissue from one or both testicles for microscopic examination. Nationally, this code is used in urology and reproductive health settings to support diagnosis of testicular masses, infertility evaluations, or other testicular pathology. It matters because accurate coding affects clinical documentation, claims adjudication, and the tracking of diagnostic services for male reproductive conditions.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for testicular biopsy, common settings where the procedure is performed, and typical billing considerations tied to CPT code 54500. The publication outlines benchmarks for utilization, coding nuances, and relevant policy updates where available. It also summarizes expected sites of service and the diagnostic purpose of the procedure.

The material is intended for clinicians, coding professionals, and payer policy analysts seeking a concise reference on CPT code 54500, its clinical role, and the payer landscape for diagnostic testicular biopsy services. Data not available in the input is noted where applicable.

Customize your policy alerts

Sign up for cpt 54500 policy alerts

Get alerted when payer policies referencing 54500 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Billing Code Overview

CPT code 54500 describes a testicular biopsy procedure in which a provider removes a tissue sample from one or both testicles using a needle for microscopic examination. The service is a diagnostic tissue sampling procedure performed to obtain histologic specimens for evaluation of testicular pathology.

Service type: Diagnostic procedure — needle biopsy

Typical site of service: Outpatient surgical suite, hospital outpatient department, or ambulatory surgery center

Find policies, billing codes, payers, states, and providers

CPT 54500: Testicular Needle Biopsy, Diagnostic Tissue Sampling

Customize your policy alerts

Sign up for cpt 54500 policy alerts

Get alerted when payer policies referencing 54500 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Billing Code Overview

Service type: Diagnostic procedure — needle biopsy

Typical site of service: Outpatient surgical suite, hospital outpatient department, or ambulatory surgery center

Clinical & Coding Specifications

Clinical Context

A 52-year-old man presents to a urology clinic with a firm, non-tender testicular mass detected by self-exam and confirmed on scrotal ultrasound. The urologist schedules an office-based percutaneous testicular biopsy using a needle under local anesthesia to obtain tissue for histopathology and immunohistochemistry. Pre-procedure workflow includes informed consent, review of coagulation status and medications (holding anticoagulants per local policy), and ultrasound localization. The procedure is performed with the patient in supine position, sterile field preparation, local infiltration anesthesia, and real-time ultrasound guidance. A core needle is advanced into one or both testicles and multiple samples are obtained, placed in formalin and sent to pathology. Post-procedure monitoring includes hemostasis, scrotal support, brief observation for bleeding or vasovagal reaction, and discharge with wound care instructions and return precautions. The pathology report provides microscopic diagnosis to guide further management such as surveillance, orchiectomy, or oncologic therapy.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the physician’s interpretive or professional portion of a service (rare for this surgical biopsy unless pathology component billed separately).
`50`	Bilateral procedure	Use when biopsy is performed on both testicles during the same session.
`52`	Reduced services	Use when the biopsy was attempted but was substantially reduced (e.g., limited sampling) compared with standard procedure.
`53`	Discontinued service	Use when the procedure was started but discontinued due to extenuating circumstances or patient condition.
`59`	Distinct procedural service	Use to indicate a separate and distinct procedure or service on the same day (for example, an additional unrelated minor procedure).
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the biopsy.
`76`	Repeat procedure by same physician	Use when the same physician repeats the biopsy procedure later the same day (note: `76` not in provided list; excluded).
`78`	Return to OR for unrelated procedure following initial procedure (not typical)	Use when the patient returns to the operating room for a related complication requiring a return trip to the OR the same or next day.
`80`	Assistant surgeon	Use when an assistant surgeon is present and participates in the procedure.
`26`	Professional component	Data duplicate entry avoided; already listed.

Taxonomy Code	Specialty	Notes
2080S0005X	Urology	Primary specialty performing testicular biopsy and management of testicular disease.
163W00000X	Diagnostic Radiology	Performs ultrasound guidance for needle localization and image-guided biopsy when required.
2086S0124X	Surgical Pathology	Anatomic pathologists process and interpret the biopsy specimen.
207L00000X	Family Medicine	May perform office-based procedures in community settings or initial evaluation and referral.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`D29.1`	Benign neoplasm of testis	Represents benign masses for which biopsy may be performed to confirm benign pathology.
`C62.9`	Malignant neoplasm of testis, unspecified	Testicular cancer suspicion prompting tissue diagnosis via biopsy or orchiectomy.
`N50.0`	Epididymitis	Inflammatory conditions may mimic masses; biopsy considered when imaging is inconclusive.
`N50.8`	Other inflammatory disorders of male genital organs	Non-specific inflammatory processes that may require histologic evaluation.
`R92.8`	Other abnormal and inconclusive findings on diagnostic imaging	Ultrasound findings that are indeterminate and necessitate tissue sampling.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`51702`	Insertion of temporary bladder catheter; simple (e.g., intermittent catheterization)	May be performed if urinary retention or bladder drainage is required perioperatively.
`76942`	Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization)	Commonly used to guide needle placement during percutaneous testicular biopsy.
`88305`	Level IV surgical pathology, gross and microscopic examination	Typical pathology code for core biopsy tissue evaluation and diagnosis.
`54150`	Circumcision, neonatal or child; simple	Not directly related but listed as a genitourinary procedure performed by urologists; included only when additional GU procedures are performed.
`54640`	Orchiectomy, simple; radical inguinal orchiectomy	Definitive surgical procedure often performed after diagnostic biopsy confirms testicular malignancy.

CPT 54505: Open Surgical Testicular Biopsy

CPT-54512-EXCISION-TESTIS-LESION-NON-PARENCHYMAL

CPT 54512: Excision of Non-parenchymal Testicular Lesion

CPT-54520-ORCHIECTOMY-SCROTAL-INGUINAL-APPROACH

CPT 54520: Orchiectomy, Scrotal or Inguinal Approach

CPT-54522-PARTIAL-EXCISION-TESTIS-BENIGN-TUMOR-CYST

CPT 54522: Partial Excision of Testis for Benign Tumor or Cyst

CPT-54530-RADICAL-INGUINAL-ORCHIECTOMY-TESTICULAR-TUMOR

CPT 54530: Radical Inguinal Orchiectomy for Testicular Tumor

CPT-54535-RADICAL-ORCHIECTOMY-ABDOMINAL-EXPLORATION

CPT 54535: Radical Orchiectomy With Abdominal Exploration

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the physician’s interpretive or professional portion of a service (rare for this surgical biopsy unless pathology component billed separately).
`50`	Bilateral procedure	Use when biopsy is performed on both testicles during the same session.
`52`	Reduced services	Use when the biopsy was attempted but was substantially reduced (e.g., limited sampling) compared with standard procedure.
`53`	Discontinued service	Use when the procedure was started but discontinued due to extenuating circumstances or patient condition.
`59`	Distinct procedural service	Use to indicate a separate and distinct procedure or service on the same day (for example, an additional unrelated minor procedure).
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the biopsy.
`76`	Repeat procedure by same physician	Use when the same physician repeats the biopsy procedure later the same day (note: `76` not in provided list; excluded).
`78`	Return to OR for unrelated procedure following initial procedure (not typical)	Use when the patient returns to the operating room for a related complication requiring a return trip to the OR the same or next day.
`80`	Assistant surgeon	Use when an assistant surgeon is present and participates in the procedure.
`26`	Professional component	Data duplicate entry avoided; already listed.

Taxonomy Code	Specialty	Notes
2080S0005X	Urology	Primary specialty performing testicular biopsy and management of testicular disease.
163W00000X	Diagnostic Radiology	Performs ultrasound guidance for needle localization and image-guided biopsy when required.
2086S0124X	Surgical Pathology	Anatomic pathologists process and interpret the biopsy specimen.
207L00000X	Family Medicine	May perform office-based procedures in community settings or initial evaluation and referral.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`D29.1`	Benign neoplasm of testis	Represents benign masses for which biopsy may be performed to confirm benign pathology.
`C62.9`	Malignant neoplasm of testis, unspecified	Testicular cancer suspicion prompting tissue diagnosis via biopsy or orchiectomy.
`N50.0`	Epididymitis	Inflammatory conditions may mimic masses; biopsy considered when imaging is inconclusive.
`N50.8`	Other inflammatory disorders of male genital organs	Non-specific inflammatory processes that may require histologic evaluation.
`R92.8`	Other abnormal and inconclusive findings on diagnostic imaging	Ultrasound findings that are indeterminate and necessitate tissue sampling.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`51702`	Insertion of temporary bladder catheter; simple (e.g., intermittent catheterization)	May be performed if urinary retention or bladder drainage is required perioperatively.
`76942`	Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization)	Commonly used to guide needle placement during percutaneous testicular biopsy.
`88305`	Level IV surgical pathology, gross and microscopic examination	Typical pathology code for core biopsy tissue evaluation and diagnosis.
`54150`	Circumcision, neonatal or child; simple	Not directly related but listed as a genitourinary procedure performed by urologists; included only when additional GU procedures are performed.
`54640`	Orchiectomy, simple; radical inguinal orchiectomy	Definitive surgical procedure often performed after diagnostic biopsy confirms testicular malignancy.

CPT 54505: Open Surgical Testicular Biopsy

CPT-54512-EXCISION-TESTIS-LESION-NON-PARENCHYMAL

CPT 54512: Excision of Non-parenchymal Testicular Lesion

CPT-54520-ORCHIECTOMY-SCROTAL-INGUINAL-APPROACH

CPT 54520: Orchiectomy, Scrotal or Inguinal Approach

CPT-54522-PARTIAL-EXCISION-TESTIS-BENIGN-TUMOR-CYST

CPT 54522: Partial Excision of Testis for Benign Tumor or Cyst

CPT-54530-RADICAL-INGUINAL-ORCHIECTOMY-TESTICULAR-TUMOR

CPT 54530: Radical Inguinal Orchiectomy for Testicular Tumor

CPT-54535-RADICAL-ORCHIECTOMY-ABDOMINAL-EXPLORATION

CPT 54535: Radical Orchiectomy With Abdominal Exploration

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 54500: Testicular Needle Biopsy, Diagnostic Tissue Sampling

Sign up for cpt 54500 policy alerts

Billing Code Overview

Catch payer policy changes before they impact reimbursement

Catch payer policy changes before they impact reimbursement

OpenPayer

CPT 54500: Testicular Needle Biopsy, Diagnostic Tissue Sampling

Sign up for cpt 54500 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References