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CPT 54861: Bilateral Epididymectomy

CPT code 54861 represents a bilateral epididymectomy — the surgical removal of the epididymis on both sides. This code is used to report definitive surgical treatment when removal of epididymal tissue is indicated for bilateral pathology. As a genitourinary surgical procedure, it is typically performed in an operating room setting or ambulatory surgery center and has relevance for surgical, urology, and hospital billing workflows nationwide.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and coding definition, payer coverage patterns, common billing modifiers used with this procedure, and benchmarking information where available. The publication outlines typical sites of service and considerations for claims processing and documentation.

The content provides practical reference material for revenue cycle, coding specialists, and clinical administrators seeking clarity on scope and classification of this procedure. Data not available in the input is clearly noted where applicable, and the focus remains on code definition, service setting, and the payers most commonly involved in coverage decisions.

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Billing Code Overview

CPT code 54861 describes a bilateral epididymectomy — the surgical removal of the epididymis on both sides. This procedure is classified as a surgical genitourinary procedure involving excision of the epididymal tissue.

Service type: Surgical procedure — genitourinary/urogenital surgery

Typical site of service: Hospital operating room or ambulatory surgery center

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CPT 54861: Bilateral Epididymectomy

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Billing Code Overview

Service type: Surgical procedure — genitourinary/urogenital surgery

Typical site of service: Hospital operating room or ambulatory surgery center

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.

Coding Specifications

Modifier	Description	When to Use
`50`	Bilateral procedure	Use when procedures are performed on both sides; however, for codes that describe bilateral procedure inherently, confirm payer policy.
`51`	Multiple procedures	Use when additional distinct procedures are reported on the same date by the same provider.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as originally planned.
`53`	Discontinued procedure	Use when the procedure is terminated due to extenuating circumstances or those that threaten patient well-being.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the procedure.
`63`	Procedure performed on infants less than 4 kg	Use when the patient meets the weight criterion and the modifier is required by payers.
`66`	Surgical team	Use when a surgical team performs the procedure and payer requires team reporting.
`73`	Discontinued outpatient hospital/ASC procedure before anesthesia	Use when procedure is discontinued prior to anesthesia administration in an outpatient setting.
`76`	Repeat procedure by same physician (not listed in raw modifiers but commonly relevant)	Data not available in the input.
`77`	Repeat procedure by another physician (not listed in raw modifiers but commonly relevant)	Data not available in the input.

Taxonomy Code	Specialty	Notes
2080S0004X	Urology	Urologists most commonly perform epididymectomy procedures.
2080P0208X	Pediatric Urology	Pediatric urologists perform epididymal surgery in pediatric patients when indicated.
363L00000X	General Surgery	General surgeons with genitourinary expertise may perform scrotal procedures in some settings.
207R00000X	Family Medicine	Family physicians do not typically perform epididymectomy but may be involved in initial evaluation and referral.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N45.0`	Acute epididymitis	Common indication when acute infection fails conservative management and complications require surgery.
`N45.1`	Chronic epididymitis	Frequent indication for epididymectomy when chronic pain or induration persists despite medical therapy.
`N45.2`	Epididymal cyst	Symptomatic cysts may necessitate excision or epididymectomy if symptomatic or recurrent.
`N45.3`	Spermatocele	Large or symptomatic spermatoceles sometimes require surgical removal involving the epididymis.
`N45.8`	Other epididymal disease	Miscellaneous epididymal pathologies that may prompt surgical removal.
`N48.0`	Hydrocele	May be present concurrently; surgical planning may address both hydrocele and epididymal pathology.

Related CPT Codes

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

CPT 54800: Needle Biopsy of Epididymis for Diagnostic Evaluation

CPT-54830-EPIDIDYMIS-LESION-EXCISION

CPT 54830: Excision of Epididymal Lesion

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

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

CPT-54860-EPIDIDYMECTOMY-UNILATERAL

CPT 54860: Unilateral Epididymectomy

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

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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.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`50`	Bilateral procedure	Use when procedures are performed on both sides; however, for codes that describe bilateral procedure inherently, confirm payer policy.
`51`	Multiple procedures	Use when additional distinct procedures are reported on the same date by the same provider.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as originally planned.
`53`	Discontinued procedure	Use when the procedure is terminated due to extenuating circumstances or those that threaten patient well-being.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the procedure.
`63`	Procedure performed on infants less than 4 kg	Use when the patient meets the weight criterion and the modifier is required by payers.
`66`	Surgical team	Use when a surgical team performs the procedure and payer requires team reporting.
`73`	Discontinued outpatient hospital/ASC procedure before anesthesia	Use when procedure is discontinued prior to anesthesia administration in an outpatient setting.
`76`	Repeat procedure by same physician (not listed in raw modifiers but commonly relevant)	Data not available in the input.
`77`	Repeat procedure by another physician (not listed in raw modifiers but commonly relevant)	Data not available in the input.

Taxonomy Code	Specialty	Notes
2080S0004X	Urology	Urologists most commonly perform epididymectomy procedures.
2080P0208X	Pediatric Urology	Pediatric urologists perform epididymal surgery in pediatric patients when indicated.
363L00000X	General Surgery	General surgeons with genitourinary expertise may perform scrotal procedures in some settings.
207R00000X	Family Medicine	Family physicians do not typically perform epididymectomy but may be involved in initial evaluation and referral.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N45.0`	Acute epididymitis	Common indication when acute infection fails conservative management and complications require surgery.
`N45.1`	Chronic epididymitis	Frequent indication for epididymectomy when chronic pain or induration persists despite medical therapy.
`N45.2`	Epididymal cyst	Symptomatic cysts may necessitate excision or epididymectomy if symptomatic or recurrent.
`N45.3`	Spermatocele	Large or symptomatic spermatoceles sometimes require surgical removal involving the epididymis.
`N45.8`	Other epididymal disease	Miscellaneous epididymal pathologies that may prompt surgical removal.
`N48.0`	Hydrocele	May be present concurrently; surgical planning may address both hydrocele and epididymal pathology.

Related CPT Codes

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

CPT 54800: Needle Biopsy of Epididymis for Diagnostic Evaluation

CPT-54830-EPIDIDYMIS-LESION-EXCISION

CPT 54830: Excision of Epididymal Lesion

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

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

CPT-54860-EPIDIDYMECTOMY-UNILATERAL

CPT 54860: Unilateral Epididymectomy

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 54861: Bilateral Epididymectomy

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Billing Code Overview

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CPT 54861: Bilateral Epididymectomy

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

CPT 54861: Bilateral Epididymectomy

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Billing Code Overview

CPT 54861: Bilateral Epididymectomy

Sign up for cpt 54861 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 54861 represent and in what setting is it typically performed?

Which modifiers are commonly used with CPT 54861 and when might they apply?

What clinical scenarios and preoperative findings commonly lead to billing CPT 54861?

Which related CPT codes should coders consider when an epididymectomy is performed or when alternative procedures are done?

Which payers are referenced for coverage in this analysis and what payer-specific consideration is highlighted?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 54861 represent and in what setting is it typically performed?

Which modifiers are commonly used with CPT 54861 and when might they apply?

What clinical scenarios and preoperative findings commonly lead to billing CPT 54861?

Which related CPT codes should coders consider when an epididymectomy is performed or when alternative procedures are done?

Which payers are referenced for coverage in this analysis and what payer-specific consideration is highlighted?

References