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See a sample rate comparisonCPT 54130 Fee Schedule
Last Verified: October 2026
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.
Remove All Or Part Of Penis, Surgical Removal Of All Or A Part Of The Penis. The Procedure May Include Removal Of Nearby Lymph Nodes.
| 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 52 - Reduced Services 82 - Assistant surgeon - no qualified resident AG - Primary physician AS - PA/NP/CNS assistant at surgery GC - Service performed by resident under supervision 22 - Increased Procedural Services |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 54130 |
| Medicaid Fee Schedule | View Medicaid rates for 54130 |
National average reimbursement for CPT 54130 by major payers:
$1,509.70
$1,595.67
$1,642.02
$1,946.00
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CPT 54130
5 of 25 sample ratesHigher to lower in this preview
Iu Health Southwest Fort Wayne Ambulatory Surgery Center LLC, Iu Health Surgery Center Fort Wayne
Iu Health Southwest Fort Wayne Ambulatory Surgery Center LLC
$7,400.00Published rateBaptist Health Surgery Center Breckenridge LLC
$1,657.00Published rateMeadowview Asc, LLC
Meadowview Asc LLC
$735.00Published rateSurgery Center Of Bji, LLC
Surgery Center Of Bji LLC
$592.00Published rateLiberty Eye Surgical Center LLC
Liberty Eye Surgical Center, LLC
$316.00Published rate
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See a sample payer proposalCPT 54130 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54130 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 54130 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 |
|---|---|---|
| 54125-CPT | High | Remove All Or Part Of Penis, Surgical Removal Of All Or A Part Of The Penis. The Procedure May Include Removal Of Nearby Lymph Nodes. |
| 54130-CPT | High | Remove All Or Part Of Penis, Surgical Removal Of All Or A Part Of The Penis. The Procedure May Include Removal Of Nearby Lymph Nodes. |
| 54135-CPT | High | Remove Penis Nodes, Amputation Of Penis Radical In Continuity With Bilateral Pelvic Lymphadenectomy Including External Iliac Hypogastric And Obturator Nodes |
| 54300-CPT | Moderate | Plastic Operation Of Penis For, Plastic Operation Of Penis For Straightening Of Chordee (Eghypospadias) With Or Without Mobilization Of Urethra |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 54130. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54130 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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