CPT 54125 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • KX - Requirements specified in the medical policy have been met • 51 - Multiple procedures |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 54125 |
National average reimbursement for CPT 54125 by major payers:
$1,050.19
$1,089.53
$1,176.40
$1,371.33
| 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 54125 | ||||||
United | 54125 | $750.00 | 1649893934 - SIMI VALLEY SURGERY CENTER INC | 841997544 - (CA) SIMI VALLEY SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54125 | $1196.00 | 1609871847 - THE SURGERY CENTER, LLC | 582520623 - (GA) THE SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54125 | $645.00 | 1043361587 - CENTER FOR ASSISTED REPRODUCTION LABORATORY AND SURGERY CENTER, INC. | 752829914 - (TX) CENTER FOR ASSISTED REPRODUCTION LABORATORY AND SURGERY CENTER INC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54125 | $645.00 | 1992248512 - LUBBOCK VASCULAR ACCESS CENTER | 352344583 - (TX) LUBBOCK INTERVENTIONAL NEPHROLOGY ASSOCIATES PA | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54125 | $1413.00 | 1821194754 - COASTAL SURGICAL SPECIALISTS, INC. | 743000596 - (CA) COASTAL SURGICAL INSTITUTE | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54125 | $500.00 | 1467783688 - PREMIER SURGICAL CENTER LLC | 261807944 - (FL) PREMIER SURGICAL CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54125 | $2064.00 | 1679943989 - LIVINGSTON ASC LLC | 474735737 - (NJ) LIVINGSTON ASC LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54125 | $650.00 | 1942455449 - HEA GRAMERCY SURGERY CENTER, PLLC, HEA SURGERY CENTER | 263722257 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54125 | $840.00 | 1730401571 - CHILDRENS SURGERY CENTER LLC, ADVENTHEALTH SURGERY CENTER MAITLAND | 262389638 - (FL) CHILDRENS SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54125 | $773.00 | 1669660817 - SPH IRVINE, L.L.C. | 752507129 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54125 | $1558.00 | 1245635093 - PARK RIDGE SURGERY CENTER, LLC | 464468691 - (CO) PARK RIDGE SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54125 | $1528.00 | 1336246099 - VALLEY BAPTIST AMBULATORY SURGERY CENTER, LLC, PLATINUM SURGERY CENTER | 871904768 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54125 | $1714.00 | 1962568543 - ENDOSCOPY CENTER OF OCEAN COUNTY, LLC | 223461117 - (NJ) ENDOSCOPY CENTER OF OCEAN COUNTY, PC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54125 | $468.00 | 1942485305 - 9106 PHILADELPHIA ROAD AMBULATORY SURGERY CENTER LLC | 261539834 - (MD) 9106 PHILADELPHIA ROAD AMBULATORY SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54125 | $600.00 | 1609882810 - LAGRECA EYE CLINIC PC, THE EYE CLINIC SURGICENTER LAGRECA EYE CLINIC | 320016290 - LAGRECA EYE CLINIC, PC | MT | 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 54125 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54125 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 54125 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 |
|---|---|---|
| 54120-CPT | Moderate | Amputation Of Penis; Partial |
| 54125-CPT | High | Amputation Penis Complete |
| 54130-CPT | High | Rad.Amput-Penis;Bil.Inguinofem.Lymp |
| 54135-CPT | High | Amputation Of Penis, Radical; In Continuity With Bilateral Pelvic Lymphadenectomy, Including External Iliac, Hypogastric And Obturator Nodes |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 54125. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54125 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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