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See a sample rate comparisonCPT 54160 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.
Circumcision Surgical Excis, Circumcision Surgical Excision Other Than Clamp Device Or Dorsal Slit Neonate 28 Days Of Age Or Less
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Male Genital System |
| Common Place of Service | 21 - Inpatient Hospital 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 59 - Distinct Procedural Service AG - Primary physician |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 54160 |
| Medicaid Fee Schedule | View Medicaid rates for 54160 |
National average reimbursement for CPT 54160 by major payers:
$278.62
$297.59
$324.77
$245.10
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CPT 54160
5 of 25 sample ratesHigher to lower in this preview
Texas Health Surgery Center Chisholm Trail, LLC
Texas Health Surgery Center Chisholm Trail LLC
$4,141.00Published rateNorth Country Orthopaedic Ambulatory Surgery Center LLC
$2,310.00Published rateSkin Cancer And Laser Surgery Center LLC
$1,549.00Published rateNorthshore Surgical Center, LLC
Northshore Surgical Center LLC
$1,050.00Published rateTodd Aud
Deaconess Hospital Inc
$179.72Published rate
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See a sample payer proposalCPT 54160 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54160 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 54160 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 |
|---|---|---|
| 54150-CPT | Low | Circumcisi Using Clamp Or Other Devic W/ Rgional Dorsal Penile, Circumcision Using Clamp Or Other Device With Regional Dorsal Penile |
| 54160-CPT | Moderate | Circumcision Surgical Excis, Circumcision Surgical Excision Other Than Clamp Device Or Dorsal Slit Neonate 28 Days Of Age Or Less |
| 54161-CPT | Moderate | Circumcisi Surg Xcision Other Than Clamp Devic Or Dorsal Sl, Circumcision Surgical Excision Other Than Clamp Device Or Dorsal Sl |
| 54162-CPT | Moderate | Repair Following Circumcision, Surgical Repair Related To A Complication Of A Circumcision. The Initial Procedure May Have Left Foreskin In Place Or Scar Tissue (Adhesion) May Have Formed. Either Can Restrict Normal Movement. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 54160. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54160 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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