CPT 54840 Spermatocele Excision Reimbursement | OpenPayer

Summary & Overview

CPT 54840: Spermatocele Excision with or without Epididymal Head Partial Excision

CPT code 54840 identifies surgical excision of a spermatocele, a benign cystic lesion situated between the epididymis and testis. This code captures procedures that remove the spermatocele with or without partial excision of the head of the epididymis and is used across outpatient and inpatient urologic surgical settings. Nationally, use of this CPT code matters for procedure tracking, surgical quality measurement, and accurate claims processing for urologic services.

Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, guidance on common billing practices, and summaries of payer coverage patterns and benchmarks where available. The publication also outlines typical sites of service and common modifiers associated with surgical codes like this one.

This resource is aimed at billing managers, urology clinicians, and policy analysts who need a clear reference on code intent, service delivery context, and payer considerations for CPT code 54840. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 54840spermatocele excisionurology surgeryscrotal surgeryoutpatient surgeryprocedure codingbilling guidancesurgical CPT

Billing Code Overview

CPT code 54840 describes the surgical removal of a spermatocele, a cyst located between the epididymis and the testis. The procedure may include excision of the spermatocele with or without partial excision of the head of the epididymis.

Service type: Surgical excision of scrotal cyst (urologic outpatient or inpatient procedure)
Typical site of service: Ambulatory surgical center or hospital operating room; may also be performed in an outpatient urology clinic with appropriate facilities

Clinical & Coding Specifications

Clinical Context

A 34-year-old male presents to a urology clinic with a painless, palpable scrotal mass superior to the testis that transilluminates and has gradually increased in size over several months. The urologist performs a focused history and physical, orders a scrotal ultrasound to confirm a cystic lesion consistent with a spermatocele, and discusses treatment options. The patient elects surgical excision due to symptomatic discomfort and cosmetic concern. The patient is scheduled for excision of the spermatocele, typically performed under general or regional anesthesia in an ambulatory surgery center or hospital outpatient department. The operative workflow includes preoperative localization, an incision in the scrotal skin, dissection to identify the spermatocele between the epididymal head and testis, careful excision of the cyst with preservation of the testis and vas deferens, hemostasis, and layered scrotal closure. Postoperative instructions address scrotal support, analgesia, wound care, and activity restrictions. Billing uses CPT code 54840 for removal of a spermatocele with or without partial excision of the epididymal head. Typical payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.

Coding Specifications

Modifier	Description	When to Use
`25`	Data not available in the input.	Data not available in the input.

Related Codes

CPT-54861-BILATERAL-EPIDIDYMECTOMY

CPT 54861: Bilateral Epididymectomy

CPT-54830-EPIDIDYMIS-LESION-EXCISION

CPT 54830: Excision of Epididymal Lesion

54800-INCISION-AND-DRAINAGE-OF-HYDROCELE-UNILATERAL-OR

CPT 54800: Incision and Drainage of Hydrocele, Unilateral or Bilateral

CPT-54860-EPIDIDYMECTOMY-UNILATERAL

CPT 54860: Unilateral Epididymectomy

Taxonomy Code	Specialty	Notes
208000000X	Urology	Urologists most commonly perform `54840` for scrotal cyst excision.
208800000X	Pediatric Urology	Pediatric urologists manage spermatocele removal in adolescents when indicated.
207R00000X	Family Medicine	Family physicians with procedural training may manage referral and pre/postoperative care.
208600000X	General Surgery	General surgeons with genitourinary experience may perform scrotal procedures in some settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N49.2`	Spermatocele	Direct diagnosis indicating a spermatocele; primary indication for `54840`.
`N50.8`	Other specified disorders of male genital organs	Used when the presenting scrotal lesion is specified but not exactly classified; may support surgical intervention.
`N45.1`	Orchitis and epididymitis in diseases classified elsewhere	Relevant when infection of epididymal structures is present and differential includes infected cyst requiring different management.
`N45.0`	Acute epididymitis	Considered in differential diagnosis; if chronic or associated pathology present, may alter operative planning.
`N48.4`	Painful scrotum	Symptom code that supports medical necessity for excision when spermatocele causes scrotal pain.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`54300`	Incision and drainage of scrotal abscess; simple	May be performed for infected scrotal lesions prior to definitive cyst excision in complicated cases.
`54311`	Partial or total excision, scrotum; simple	Alternate scrotal excision code for superficial scrotal lesions when spermatocele excision is not applicable.
`54520`	Exploration of scrotum and contents with removal of foreign body, or drainage of hematoma or abscess	Performed when additional scrotal exploration or drainage is required during removal of a spermatocele.
`54700`	Repair of dilated spermatic cord veins (varicocelectomy), unilateral	May be performed in the same operative session if a concurrent varicocele is identified and addressed.
`55970`	Biopsy, prostate; needle or punch (separate procedure)	Data not directly related but sometimes performed in broader genitourinary surgical sessions; included for cross-reference.