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See a sample rate comparisonCPT 54100 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.
Biopsy Of Penis
| 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 76 - Repeat procedure by same physician |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 54100 |
| Medicaid Fee Schedule | View Medicaid rates for 54100 |
National average reimbursement for CPT 54100 by major payers:
$241.53
$257.16
$281.46
$213.05
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CPT 54100
5 of 25 sample ratesHigher to lower in this preview
Texas Health Harris Methodist Hospital Fort Worth
Texas Health Harris Methodist Hospital Southwest Fort Worth
$3,607.00Published rateHastings Surgical Center, LLC, Hastings Surgical Center
Hastings Surgical Center LLC
$1,334.00Published ratePosada Ambulatory Surgery Center, Lp
Posada Ambulatory Surgery Center, L.P.
$819.50Published rateWomen'S Surgical Center At Northcare, LLC
Women S Surgical Center At Nor
$687.00Published rateSurgery Center 121 LLC
$425.00Published rate
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See a sample payer proposalCPT 54100 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54100 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 54100 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 |
|---|---|---|
| 54100-CPT | Moderate | Biopsy Of Penis |
| 54105-CPT | Moderate | Biopsy Penis Deep Structures |
| 54110-CPT | Moderate | Treatment For Plaque In Penis, Surgery To Remove The Fibrous Tissue That Forms Within The Penis In Peyronies Disease. The Procedure May Involve Skin Grafts To Reconstruct An Area. |
| 54111-CPT | High | Treatment For Plaque In Penis, Surgery To Remove The Fibrous Tissue That Forms Within The Penis In Peyronies Disease. The Procedure May Involve Skin Grafts To Reconstruct An Area. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 54100. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54100 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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