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See a sample rate comparisonCPT 54105 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 Penis Deep Structures
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Male Genital System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None 51 - Multiple procedures 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 54105 |
| Medicaid Fee Schedule | View Medicaid rates for 54105 |
National average reimbursement for CPT 54105 by major payers:
$349.06
$361.81
$373.33
$354.88
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CPT 54105
5 of 25 sample ratesHigher to lower in this preview
Franciscan Surgery Center, LLC
$7,688.00Published ratePhysicians Surgery Services Lp, Advanced Surgery Center
Physician Surgery Services L.P.
$2,650.00Published rateSurgical Associates Northwest, PC, Rainier Surgical Center
Surgical Associates Northwest, PC
$1,192.00Published rateTresanti Surgical Center LLC, Tresanti Medical Corporation
Tresanti Surgical Center LLC
$819.50Published rateAesthetic Associates Inc., P.S., Seattle Facial Plastic Surgery Center
Aesthetic Associates Inc Ps
$520.00Published rate
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See a sample payer proposalCPT 54105 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54105 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 54105 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 54105. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54105 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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