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See a sample rate comparisonCPT 53454 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Periurethral Tprnl Adjtbl Balo Cntnc Dev Adjmt, Periurethral Transperineal Adjustable Balloon Continence Device; Percutaneous Adjustment Of Balloon(S) Fluid Volume
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Urinary System |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 59 - Distinct Procedural Service 50 - Bilateral Procedure |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 53454 |
| Medicaid Fee Schedule | View Medicaid rates for 53454 |
National average reimbursement for CPT 53454 by major payers:
$79.12
$31.91
$50.95
$92.66
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CPT 53454
5 of 25 sample ratesHigher to lower in this preview
Memorial Hermann Endoscopy Center North Freeway LLC, Memorial Hermann Endoscopy Center North Loop
$2,079.00Published rateWest Suburban Eye Surgery Center LLC, Surgisite North
West Suburban Eye Surgery Center, LLC
$579.00Published rateNatick Surgery Center, LLC
Natick Surgery Center LLC
$525.00Published rateLakewood Asc, LLC
Lakewood Asc LLC
$103.00Published rateChildrens Surgery Center Of Malvern, LLC
Childrens Surgery Center Of Malvern LLC
$65.00Published rate
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See a sample payer proposalCPT 53454 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 53454 code is part of the Surgery services used for Surgical Procedures on the Urinary System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 53454 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 53451-CPT | High | Periurethral Tprnl Adjtbl Balo Cntnc Dev Bi Insj, Periurethral Transperineal Adjustable Balloon Continence Device; Bilateral Insertion Including Cystourethroscopy And Im |
| 53452-CPT | High | Periurethrl Tprnl Adjtbl Balo Cntnc Dev Uni Insj, Periurethral Transperineal Adjustable Balloon Continence Device; Unilateral Insertion Including Cystourethroscopy And I |
| 53453-CPT | High | Remove Incontinence Device, Surgery To Remove An Implanted Device In The Tissue Surrounding The Urethra Used To Treat Urinary Incontinence. |
| 53454-CPT | Low | Periurethral Tprnl Adjtbl Balo Cntnc Dev Adjmt, Periurethral Transperineal Adjustable Balloon Continence Device; Percutaneous Adjustment Of Balloon(S) Fluid Volume |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 53454. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 53454 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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