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CPT 54505: Open Surgical Testicular Biopsy
CPT code 54505 covers an open surgical biopsy of one or both testicles via an incision in the scrotum, with tissue sent for microscopic examination. This procedure is used to obtain diagnostic tissue when less invasive sampling is inadequate or contraindicated, and it has implications for urologic oncology, fertility evaluation, and acute scrotal pathology. Nationally, accurate coding and site-of-service determination affect claims adjudication, clinical tracking, and resource planning for surgical services.
Key payers discussed in this publication include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise clinical context for the procedure, comparisons to related testis procedures, typical sites of service, and the ICD-10 diagnoses commonly associated with this service. The report also outlines common claim considerations and related procedural codes to assist coding professionals, billers, and policy analysts in understanding where 54505 fits within the spectrum of testicular procedures.
This summary provides practical clarity on clinical intent, common use cases, and the coding relationships that matter for national billing and policy discussions without state-specific guidance.
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Billing Code Overview
CPT code 54505 describes an open surgical testicular biopsy in which the provider removes a tissue sample from one or both testicles through an incision in the scrotum. The recovered tissue specimen is subsequently examined microscopically for diagnostic evaluation.
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Service type: Surgical biopsy procedure
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Typical site of service: Hospital outpatient department or ambulatory surgical center, with possible performance in an inpatient surgical setting depending on clinical context
National Reimbursement Benchmarks
Commercial averages sit well above Medicare: Blue Cross Blue Shield’s mean ($2,302.60) and BUCA’s mean ($1,442.00) notably exceed Medicare’s mean ($197.20), indicating a substantial gap between commercial and government reimbursement for CPT 54505. UnitedHealth Group ($372.40), Cigna ($357.50), and Aetna ($154.10) occupy intermediate positions, with Aetna closer to Medicare and UnitedHealth Group and Cigna closer to BUCA’s lower commercial band.
Dispersion varies widely: Blue Cross Blue Shield has the largest interquartile spread (P75–P25 = $3,589.90 − $454.10 = $3,135.80), followed by UnitedHealth Group ($465.10 − $231.10 = $234.00) and BUCA ($2,214.70 − $330.80 = $1,883.90). The tightest distribution is Aetna ($222.00 − $44.40 = $177.60), then Cigna ($456.10 − $224.00 = $232.10). These differences highlight substantial variability in commercial market pricing versus Medicare’s much narrower local range (P75–P25 = $203 − $189 = $14).