CPT 54056 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Male Genital System |
| Common Place of Service | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • UA |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 54056 |
National average reimbursement for CPT 54056 by major payers:
$171.63
$180.52
$198.97
$239.04
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 54056 | ||||||
United | 54056 | $219.00 | 1700843208 - FAYETTEVILLE AMBULATORY SURGERY CENTER LIMITED PARTNERSHIP, FAYETTEVILLE AMBULATORY SURGERY CENTER | 561754482 - (NC) FAYETTEVILLE AMBULATORY SURGERY | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54056 | $169.00 | 1053496240 - OAKLAND CA ENDOSCOPY ASC LP, EAST BAY ENDOSURGERY CENTER | 205645928 - (CA) OAKLAND CA ENDOSCOPY ASC LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54056 | $130.00 | 1588119283 - DOCTORS OUTPATIENT SURGERY CENTER LLC, DOCTORS OUTPATIENT SURGERY CENTER | 364835603 - (NE) DOCTORS OUTPATIENT SURGERY CENTER, LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54056 | $555.00 | 1972886190 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54056 | $390.00 | 1124055165 - SALINA UROLOGY CARE CENTER LLC | 522407155 - (KS) SALINA UROLOGY CARE CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54056 | $88.00 | 1336138635 - EYE SURGICAL SPECIALISTS OF NEW JERSEY, SURGERY CENTER OF CENTRAL NEW JERSEY | 223411416 - (NJ) EYE SURGICAL SPECIALISTS OF NEW JERSEY | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54056 | $139.00 | 1033116892 - CENTER FOR UROLOGIC CARE OF BERKS CO PC, BERKS UROLOGIC SURGERY CENTER | 231727298 - (PA) CENTER FOR UROLOGIC CARE OF BERKS COUNTY, P.C. | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54056 | $120.00 | 1093726309 - INSIGHT SURGERY & LASER CENTER, LLC | 203458868 - (OH) INSIGHT SURGERY LASER CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54056 | $420.00 | 1255397808 - JOLIET SURGERY CENTER LIMITED PARTNERSHIP, AMSURG SURGERY CENTER | 742544709 - (IL) JOLIET SURGERY CENTER LIMITED PARTNERSHIP | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54056 | $128.00 | 1558859645 - EAST FREEDOM SURGICAL ASSOCIATES, LLC | 820930718 - (PA) EAST FREEDOM SURGICAL ASSOCIATES LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54056 | $422.26 | 1396990701 - PEACEHEALTH, ST JOSEPH MEDICAL CENTER | 910565889 - PEACEHEALTH ST JOSEPH MEDICAL CENTER | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54056 | $1831.00 | 1083644124 - MEMORIAL HERMANN SURGERY CENTER SOUTHWEST LLP, MEMORIAL HERMANN SURGERY CENTER SOUTHWEST | 202866884 - (TX) MEMORIAL HERMANN SURGERY CENTER SOUTHWEST LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54056 | $574.00 | 1093772840 - THE SURGERY CENTER AT JENSEN BEACH, LLC | 651198731 - (FL) THE SURGERY CENTER AT JENSEN B | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54056 | $250.00 | 1043564784 - COMPREHENSIVE SURGICAL CENTER OF GREEN, LLC | 461313857 - (OH) COMPREHENSIVE SURGICAL CENTER OF GREEN LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54056 | $365.00 | 1629145685 - IDAHO EYE CENTER PA, IDAHO EYE SURGICENTER | 820379995 - (ID) IDAHO EYE CENTER, P.A. | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 54056 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54056 code is part of the Surgery services used for Surgical Procedures on the Male Genital 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 54056 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 |
|---|---|---|
| 54050-CPT | Low | Destruc Lesion,Penis,Smple;Chemical |
| 54055-CPT | Low | Destruction Of Lesion(S), Penis (Eg, Condyloma, Papilloma, Molluscum Contagiosum, Herpetic Vesicle), Simple; Electrodesiccation |
| 54056-CPT | Low | Destruction Of Lesion(S), Penis (Eg, Condyloma, Papilloma, Molluscum Contagiosum, Herpetic Vesicle), Simple; Cryosurgery |
| 54057-CPT | Low | Destruction Of Lesion(S), Penis (Eg, Condyloma, Papilloma, Molluscum Contagiosum, Herpetic Vesicle), Simple; Laser Surgery |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 54056. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54056 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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