Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.30
    OpenPayerBilling CodesExcision Procedures on the TestisCPT cpt-54530-radical-inguinal-orchiectomy-testicular-tumor
    Ask Trek AI about this page

    CPT 54530: Radical Inguinal Orchiectomy for Testicular Tumor

    Medicare pays $479 on average nationally for this procedure.

    CPT code 54530 describes a radical orchiectomy in which the provider excises and completely removes one or both testes through an inguinal (groin) approach to treat a tumor; service type: surgical procedure (urologic/oncologic); typical site of service: operating room or ambulatory surgical center for definitive tumor resection and pathological evaluation.

    For related coverage guidance, see recent payer policy updates: Removal of Implantable, Outpatient Surgical Procedures - Site of Service, Surgical Procedures.

    Customize your policy alerts

    Sign up for cpt 54530 policy alerts

    Get alerted when payer policies referencing 54530 are released or updated.

    Monitor payer policy activity

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

    Table of contents

    Progress1 / 7

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • Facility ComparisonBeds, revenue & payer mix
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult male presenting with a painless testicular mass or scrotal swelling identified on exam or ultrasound suspicious for testicular neoplasm. After evaluation (history, physical exam, scrotal ultrasound, serum tumor markers such as AFP, hCG, and LDH), the patient is scheduled for a radical inguinal orchiectomy to remove the affected testis for definitive diagnosis and local control. The clinical workflow includes preoperative counseling and consent, preoperative anesthesia assessment, surgical excision via an inguinal (groin) approach with high ligation of the spermatic cord, specimen submission to pathology, postoperative recovery with pain control and scrotal support, and outpatient follow-up for pathology results and staging discussions. Typical perioperative documentation includes indication, laterality, procedure note describing inguinal incision, mobilization and control of the spermatic cord, removal of the testis and cord to the level of the internal ring, estimated blood loss, complications (if any), and instructions for follow-up care and oncology referral if malignancy is confirmed.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    54520Orchiectomy, simple or subcapsular, unilateral or bilateral (separate procedure)Alternative technique for non-radical testis removal; may be used for benign pathology or as a less extensive excision.
    54220Biopsy of testis or epididymisPerformed when tissue diagnosis is attempted prior to definitive orchiectomy in select cases.
    54535Removal of undescended testis (orchidopexy) — not appropriate for tumor resectionMay appear in differential workflow when orchiectomy is performed for an undescended testis with tumor suspicion, but procedural intent differs.
    54150Exploration of scrotum for testicular torsion or scrotal explorationPerformed when emergent scrotal exploration occurs; can precede or be an alternative to orchiectomy in salvageable testes.
    88305Surgical pathology, gross and microscopic examination (level III)Pathology CPT commonly billed for histologic evaluation of orchiectomy specimen to confirm tumor type and margins.

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    163WX0106X
    207VG0400X
    103T00000X
    315P00000X
    172P00000X
    207VX0201X
    222Q00000X
    246Z00000X

    Related ICD-10-CM Codes

    24 rows

    ICD-10-CM CodeDescription
    C62.11Malignant neoplasm of descended right testis
    C62.12Malignant neoplasm of descended left testis
    C62.91Malignant neoplasm of right testis, unspecified whether descended or undescended
    C79.10Secondary malignant neoplasm of unspecified urinary organs
    C79.11Secondary malignant neoplasm of bladder
    C79.2Secondary malignant neoplasm of skin
    D07.5Carcinoma in situ of prostate
    D41.4Neoplasm of uncertain behavior of bladder
    D49.2Neoplasm of unspecified behavior of bone, soft tissue, and skin
    N40.0Benign prostatic hyperplasia without lower urinary tract symptoms

    Showing 1–10 of 24

    Related Payer Policy Updates

    Specialty: General Surgery1 / 2

    10 rows

    PolicyPayerEffective Date
    Removal of ImplantableBlue Cross Blue Shield - Rhode Island2026-10-01
    Outpatient Surgical Procedures - Site of ServiceUnitedHealthcare2026-09-01
    Surgical ProceduresUnitedHealthcare2026-09-01
    Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsPremera Bluecross2026-09-01
    Site of Service Ambulatory Surgical Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsPremera Bluecross2026-09-01
    Site of Service Ambulatory Service Center (ASC) SelectPremera Bluecross2026-09-01
    Site of Service Ambulatory Surgical Center (ASC) Select — Site of Service for Ambulatory Surgical Procedures (ASC Select)Premera Bluecross2026-09-01
    Site of Service Ambulatory Service Center (ASC) SelectPremera Bluecross2026-09-01
    Medical Necessity Guidelines Inpatient Surgical CareMass General Brigham Health Plan2026-08-01
    Outpatient Surgical Procedures - Site of Servicesierra health and life2026-08-01

    Related Codes

    CPT-54500-TESTICULAR-NEEDLE-BIOPSY

    CPT 54500: Testicular Needle Biopsy, Percutaneous

    CPT-54505-OPEN-SURGICAL-TESTICULAR-BIOPSY

    CPT 54505: Open Scrotal Testicular Biopsy

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

    CPT 54512: Excision of Nonparenchymal Testicular Lesion

    CPT-54520-ORCHIECTOMY-SCROTAL-INGUINAL-APPROACH

    CPT 54520: Orchiectomy with or without Testicular Prosthesis

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

    CPT 54522: Partial Excision of One or Both Testes for Benign Tumor or Cyst

    CPT-54535-RADICAL-ORCHIECTOMY-ABDOMINAL-EXPLORATION

    CPT 54535: Orchiectomy with Abdominal Exploration for Tumor

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
    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.