CPT 54115 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 | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • GC - Service performed by resident under supervision • 51 - Multiple procedures |
| Complexity Level | Moderate |
| CMS | $449.29 Physician Fee Schedule |
National average reimbursement for CPT 54115 by major payers:
$566.89
$606.03
$628.96
$767.69
| 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 54115 | ||||||
United | 54115 | $2859.00 | 1316291867 - PACIFIC ENDOSCOPY LLC, ATHERTON ENDOSCOPY CENTER | 460842370 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54115 | $1401.00 | 1922280197 - NORTH OAK AMBULATORY SURGERY CENTER, LLC | 261479859 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54115 | $373.01 | 1447825377 - PAIGE RUDDICK | 350593390 - DEACONESS HOSPITAL INC | IN | Certified Registered Nurse Anesthetist (367500000X) |
United | 54115 | $1500.00 | 1508437385 - SPEEDWAY SURGICAL SPECIALISTS, LLC | 852710010 - (AZ) SPEEDWAY SURGICAL SPECIALISTS LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54115 | $373.01 | 1497799100 - SHERRI WALLING | 350593390 - DEACONESS HOSPITAL INC | IN | Nurse Practitioner (363L00000X) |
United | 54115 | $811.84 | 1386664852 - HIRAK SEN | 350593390 - DEACONESS HOSPITAL INC | FL | Clinical Cardiac Electrophysiology Physician (207RC0001X) |
United | 54115 | $2762.00 | 1891175188 - PHOENIX SPINE GOODYEAR ASC, LLC, PHOENIX SPINE SURGERY CENTER | 562311366 - (AZ) PHOENIX SPINE GOODYEAR, LTD. | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54115 | $920.00 | 1750612446 - BAY SURGERY CENTERS, CLEARWAY SURGERY CENTER OF GLEN BURNIE | 271271303 - (MD) BAY SURGERY CENTERS | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54115 | $2388.00 | 1205023280 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54115 | $2564.00 | 1083912745 - RED ROCKS SURGERY CENTERS, LLC | 271095323 - (CO) RED ROCKS SURGERY CENTERS LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54115 | $1723.00 | 1861766016 - HAYS SURGERY CENTER, LLC | 274579547 - (TX) HAYS SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54115 | $1200.00 | 1225221435 - GALLERIA SURGERY CENTER LLC | 731713874 - (MD) GALLERIA SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54115 | $611.00 | 1043565542 - MAGNOLIA SURGERY CENTER, LLC | 364702180 - (AR) MAGNOLIA SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54115 | $1377.00 | 1922664622 - PREMIER CARDIAC SURGERY CENTER, PLLC, PREMIER CARDIAC SURGERY CENTER, LLC | 824896471 - (IL) PREMIER CARDIAC SURGERY CENTER PLLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54115 | $1550.00 | 1841840758 - GULFSTREAM PARC ASC LLC | 843025864 - (TX) GULFSTREAM PARC ASC LLC | TX | 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 54115 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54115 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 54115 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 |
|---|---|---|
| 54112-CPT | High | Excis Penile Plaque;W/Grft Ovr 5 Cm |
| 54115-CPT | Moderate | Removal Fb Penis (Implant) |
| 54406-CPT | Moderate | Removal Of All Components Of Multi-Component, Inflatable Penile Prosthesis Without Replacement Of Prosthesis - Rn Review<6/20/2013 |
| 54408-CPT | Moderate | Repair Of Component(S) Of A Multi-Component, Inflatable Penile Prosthesis |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 54115. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54115 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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