CPT 54162 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 | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 51 - Multiple procedures |
| Complexity Level | Moderate |
| CMS | $249.72 Physician Fee Schedule |
National average reimbursement for CPT 54162 by major payers:
$333.05
$347.41
$378.68
$437.06
| 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 54162 | ||||||
United | 54162 | $3500.00 | 1154844553 - LONE STAR ENDOSCOPY CENTER, LLC, LONE STAR ENDOSCOPY SOUTHLAKE | 273635726 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54162 | $1125.00 | 1306958103 - NEI AMBULATORY SURGERY CENTER INC PC | 232429169 - (PA) NEI AMBULATORY SURGERY CENTER INC PC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54162 | $2080.00 | 1821453796 - MASON RIDGE AMBULATORY SURGERY CENTER LP, GATEWAY ENDOSCOPY CENTER | 205953364 | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54162 | $954.00 | 1255472841 - LYNN EYE SURGERY CENTER, LLC, LYNN EYE SURGERY CENTER | 770048452 - (CA) LYNN EYE SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54162 | $1310.00 | 1558339424 - PREMIER SURGERY CENTER | 352206509 - (CA) PREMIPREMIER SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54162 | $2884.00 | 1154785848 - PROSPECT CCMC, LLC | 811507712 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54162 | $1080.00 | 1154352847 - ATLANTA SURGERY CENTERS, ATLANTA SURGERY CENTERS | 270318863 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54162 | $4141.00 | 1851650428 - TEXAS HEALTH OUTPATIENT SURGERY CENTER ALLIANCE | 822296081 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54162 | $2044.00 | 1689200305 - THE REGENTS OF THE UNIVERSITY OF CALIFORNIA, UCLA DEPT OF MEDICINE | 954373071 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54162 | $1535.00 | 1902070832 - GASTRO OPERATING COMPANY LLC, (DBA) MEADOWBROOK ENDOSCOPY CENTER | 202432134 - (NY) GASTRO OPERATING COMPANY, LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54162 | $2859.00 | 1992827992 - ATHERTON PLASTIC SURGERY CENTER | 460842370 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54162 | $1840.00 | 1659772648 - SURGICAL SPECIALTY CENTER OF MID ATLANTIC, LLC | 465727021 - (MD) SURGICAL SPECIALTY CENTER OF MID-ATLANTIC, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54162 | $3599.00 | 1003138736 - NEWPORT SURGICAL PARTNERS LLC, NEWPORT PLAZA SURGICAL CENTER | 392060266 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54162 | $2002.00 | 1750036174 - GLACIER SURGICAL INC. | 861271667 | MT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54162 | $908.00 | 1043497019 - PIKESVILLE MD ENDOSCOPY ASC LLC, ENDOCENTRE OF BALTIMORE | 261467040 | 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 54162 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54162 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 54162 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 |
| 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 |
| 54300-CPT | Moderate | Plastic Operation Of Penis For Straightening Of Chordee (Eg, Hypospadias), 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 54162. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54162 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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