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 EpididymisCPT cpt-54861-bilateral-epididymectomy
    Ask Trek AI about this page

    CPT 54861: Bilateral Epididymectomy

    Medicare pays $530 on average nationally for this procedure.

    CPT code 54861 describes a bilateral epididymectomy, the surgical removal of the epididymis on both sides, performed as a surgical procedure typically in an operating room or ambulatory surgical center under appropriate anesthesia; this code is used for billing when the provider removes both epididymides during the same operative session.

    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 54861 policy alerts

    Get alerted when payer policies referencing 54861 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 / 6

    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 chronic scrotal pain, persistent epididymal mass, or recurrent epididymitis refractory to medical therapy. The patient has undergone preoperative evaluation including history, physical examination, scrotal ultrasound confirming pathology localized to the epididymis (e.g., nodular epididymitis, spermatocele involving the epididymis, or chronic indurative epididymitis). Conservative management (antibiotics, analgesics, scrotal support) failed, and the urologist recommends surgical removal of the epididymis on both sides.

    Preoperative workflow includes informed consent, review of patient comorbidities, anesthesia evaluation (general or regional), and marking of laterality. The procedure is performed in an ambulatory surgery center or hospital operating room. Intraoperative steps include scrotal incision(s), isolation of testis and epididymis, ligation of epididymal vessels and ducts, and careful hemostasis with preservation of the testis when indicated. Bilateral approach is documented. Postoperative care includes recovery monitoring, analgesia, wound care instructions, and follow-up to assess pain control, wound healing, and fertility counseling if relevant.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    54140Excision of lesion of scrotum; simplePerformed for superficial scrotal lesions that may be concurrent or differential to epididymal pathology.
    55100Drainage of spermatocele or epididymal cystMay be performed as a less invasive alternative or preceding diagnostic/therapeutic interventions.
    54520Repair of testicular torsion; exploration and fixationPerformed when exploration reveals torsion or when scrotal exploration is indicated for acute presentations.
    54500Excision of epididymal cystRelated procedure addressing focal epididymal cystic disease; may be coded when only cyst excision is performed.
    55250Exploration of spermatic cordPerformed when additional exploration of the spermatic cord is necessary during epididymal surgery.

    Related Modifiers

    10 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…
    63Modifier‑63 is appended to surgical CPT codes (20000–69990) when a procedure is performed on a neonate or infant weighing ≤ 4 kg (about 8.8 lbs). The AMA/AAPC definition specifies this use and notes…- Use modifier -63 only for surgical procedures in the CPT 20000–69990 series performed on a neonate or infant who weighs ≤ 4 kg at the time of the procedure; it indicates increased complexity due 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…
    73Modifier 73 indicates a facility-level outpatient hospital or ASC procedure that was discontinued after the patient was prepared and taken to the procedure/operating room but before any anesthesia…- When to use: Apply CPT modifier 73 on the FACILITY (outpatient hospital or ASC) claim when the patient has been fully prepared and physically taken into the procedure/operating room but the…
    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…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    2080P0208X
    363L00000X
    207R00000X
    2080T0002X
    207SG0207X
    225XP0019X
    208C00000X
    2251E1200X

    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-54800-EPIDIDYMAL-NEEDLE-BIOPSY-DIAGNOSTIC

    CPT 54800: Epididymis Needle Biopsy

    CPT-54830-EPIDIDYMIS-LESION-EXCISION

    CPT 54830: Excision of Lesion of Epididymis

    CPT-54840-SPERMATOCELE-EXCISION-EPIDIDYMAL-PARTIAL-EXCISION

    CPT 54840: Spermatocele Excision (Epididymal Cyst)

    CPT-54860-EPIDIDYMECTOMY-UNILATERAL

    CPT 54860: Epididymectomy, Unilateral

    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.