CPT 54160 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 | • 21 - Inpatient Hospital • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • AG - Primary physician |
| Complexity Level | Moderate |
| CMS | $214.46 Physician Fee Schedule |
National average reimbursement for CPT 54160 by major payers:
$278.62
$297.59
$324.77
$364.94
| 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 54160 | ||||||
United | 54160 | $391.17 | 1225476146 - JACKLYN OAKLEY | 350593390 - DEACONESS HOSPITAL INC | IN | Family Medicine Physician (207Q00000X) |
United | 54160 | $1530.00 | 1437123270 - EDINA MN OPHTHALMOLOGY ASC LLC, MCCANNEL EYE SURGERY | 200487963 - (MN) EDINA MN OPHTHALMOLOGY ASC LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54160 | $1530.00 | 1174502561 - YANKTON MEDICAL CLINIC PC | 460363830 - (SD) YANKTON MEDICAL CLINIC, P.C. | SD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54160 | $1354.00 | 1689216152 - BAPTIST HEALTH SURGERY CENTER LLC | 843280181 - (KY) BAPTIST HEALTH SURGERY CENTER, L | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54160 | $1292.00 | 1780764829 - NOVAMED SURGERY CENTER OF ST PETERS LLC, ST PETERS AMBULATORY SURGERY CENTER | 205579933 - (MO) NOVAMED SURGERY CENTER OF ST PETERS LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54160 | $1100.00 | 1386280436 - OCOTILLO SURGERY CENTER LLC | 830970019 - (AZ) OCOTILLO SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54160 | $391.17 | 1881031821 - LINDSEY TAYLOR | 350593390 - DEACONESS HOSPITAL INC | IN | Pediatrics Physician (208000000X) |
United | 54160 | $2353.00 | 1629508387 - WELLINGTON ENDOSCOPY CENTER LLC | 813254698 - (FL) WELLINGTON ENDOSCOPY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54160 | $1050.00 | 1659679074 - EYE SURGERY CENTER OF MIDDLE TENNESSEE, LLC | 275124581 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54160 | $479.00 | 1508054818 - CUMMINS WOMENS HEALTHCARE LLC, ELIZABETH CUMMINS MD | 522110421 - (OH) CUMMINS WOMENS HEALTHCARE, LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54160 | $2388.00 | 1306421268 - COLORADO UROLOGIC SURGERY CENTER, LLC, COLORADO UROLOGIC SURGERY CENTER | 851926897 - (CO) COLORADO UROLOGIC SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54160 | $391.17 | 1124150685 - DAVID FISH | 350593390 - DEACONESS HOSPITAL INC | IN | Anesthesiology Physician (207L00000X) |
United | 54160 | $1339.00 | 1508135658 - SURGERY CENTER OF ATHENS LLC | 450581955 - (GA) SURGERY CENTER OF ATHENS LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54160 | $1708.00 | 1023297553 - PHYSICIANS SURGERY CENTER, LLC | 260425547 - (IL) PHYSICIANS SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54160 | $1009.00 | 1568083103 - COLUMBIA PARKWAY SURGERY CENTER LLC | 850692755 - (MD) COLUMBIA PARKWAY SURGERY CENTER LLC | MD | 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 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 | Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block |
| 54160-CPT | Moderate | Circumcision, Surgical Excision Other Than Clamp, Device, Or Dorsal Slit; Neonate (28 Days Of Age Or Less) |
| 54161-CPT | Moderate | Circumcision, Surgical Excision Other Than Clamp, Device, Or Dorsal Slit; Older Than 28 Days Of Age |
| 54162-CPT | Moderate | Lysis Or Excision Of Penile Post-Circumcision Adhesions |
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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