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2025 CPT code 54640

Orchiopexy performed via an inguinal or scrotal approach to reposition an undescended testicle into the scrotum.

Refer to the AMA CPT manual and payer-specific guidelines for the most current coding practices.The revision of 54640 in 2020 clarifies that hernia repair should be billed separately if it constitutes significant additional work.

Modifiers 50 (bilateral procedure) and other relevant modifiers may apply depending on the circumstances of the procedure.

Medical necessity is established when the undescended testicle presents a risk of infertility, malignancy, or other complications. Documentation should support the clinical rationale for the surgery.

The surgeon is responsible for all aspects of the orchiopexy, including pre-operative evaluation, surgical technique, and post-operative care.

IMPORTANT:For bilateral procedures, use modifier 50.If inguinal hernia repair is performed concurrently, report codes 49495-49525 separately. For exploration of an undescended testis, use code 54560. For intra-abdominal testicle fixation via open abdominal approach, use code 54650; for laparoscopic approach, use code 54692.

In simple words: This surgery moves an undescended testicle (a testicle that hasn't dropped into the scrotum) into its correct position in the scrotum.A small cut is made in the groin area and/or the scrotum to allow the testicle to be moved and secured.

Orchiopexy, an operative procedure to relocate an undescended testicle into the scrotum, is performed using an inguinal and/or scrotal approach.The procedure involves an incision in the inguinal region to locate and mobilize the testicle, followed by a scrotal incision to create a dartos pouch. The testicle is then positioned within the pouch, and both incisions are closed.If a scrotal-only approach is used, an incision is made in the high scrotal fold, a dartos pouch is created, the spermatic cord is freed and lengthened as needed, the testicle is placed into the pouch, anchored, and the incision closed with absorbable sutures. This procedure addresses cryptorchidism in infants and may be used for testicular torsion in adults.

Example 1: A 6-month-old male infant presents with cryptorchidism (undescended right testicle).Orchiopexy is performed via an inguinal approach., A 12-year-old boy with a retractile testicle requiring surgical fixation undergoes orchiopexy via a scrotal approach., A 25-year-old man presents with a history of testicular torsion, requiring orchiopexy.An inguinal approach is used due to the position of the testicle.

* Preoperative evaluation including physical examination, imaging (ultrasound), and indication for surgery.* Operative report detailing the approach (inguinal, scrotal, or both), surgical technique, and findings.* Postoperative care including pain management and follow-up.* Any complications encountered during the procedure or post-operative period.

** Accurate coding requires detailed documentation specifying the surgical approach (inguinal, scrotal, or combined), any associated hernia repair, and whether the procedure was performed bilaterally. Always refer to the most current CPT guidelines and payer-specific policies for proper coding and reimbursement.

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