Summary & Overview
CPT 54640: Orchiopexy via Inguinal or Scrotal Approach
CPT code 54640 represents an orchiopexy using an inguinal and/or scrotal approach to mobilize and fix undescended testicle(s) into the scrotum. Nationally, this code covers a common pediatric and urologic surgical procedure that addresses cryptorchidism, with implications for fertility preservation, malignancy risk reduction, and standardization of surgical coding and payment. Payers commonly applying policies to this code include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of clinical context and typical sites of care, plus a summary of payer coverage patterns and commonly associated billing modifiers. The publication outlines benchmarks for utilization and reimbursement where available, summarizes relevant policy updates that affect coding and preauthorization, and provides practical coding notes to improve claim accuracy. The content is intended for clinicians, coding professionals, and revenue cycle staff seeking a national perspective on billing for orchiopexy procedures represented by CPT code 54640.
Data not available in the input for specific ICD-10 pairings, associated taxonomies, and related codes; those items are noted as unavailable.
Billing Code Overview
CPT code 54640 describes an orchiopexy performed via an inguinal and/or scrotal approach to relocate one or more undescended testicles into the scrotum. This procedure is a surgical corrective intervention for cryptorchidism or undescended testis.
Service type: Surgical procedure — pediatric/urologic surgery
Typical site of service: Ambulatory surgical center or hospital operating room, with possible performance in an outpatient surgical suite depending on patient age and clinical factors.
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Clinical & Coding Specifications
Clinical Context
A typical patient is a pediatric male, often presenting between 6 months and 2 years of age, referred by a pediatrician for an undescended testicle (cryptorchidism). The child undergoes preoperative evaluation including history, physical exam, and anesthetic assessment. Imaging is uncommon but may be used if the testis is nonpalpable. In the operating room under general anesthesia, the surgeon performs an orchiopexy via an inguinal and/or scrotal approach to mobilize and fix the undescended testicle into the scrotum. Intraoperative steps include identification of the testis and spermatic cord, high ligation of a persistent processus vaginalis if present, adequate mobilization to avoid tension, and scrotal fixation. Postoperative workflow includes PACU recovery, pain control, wound care instructions, and outpatient follow-up to assess testicular position and viability. Typical sites of service are the hospital operating room or ambulatory surgical center. Common payors encountered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the surgeon’s professional service separate from facility charges (rare for surgery-only CPT but used if technical component billed separately). |
50 |