Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 54163 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.
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.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Male Genital System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None 51 - Multiple procedures SG - Scene to Hospital ESRD facility |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 54163 |
| Medicaid Fee Schedule | View Medicaid rates for 54163 |
National average reimbursement for CPT 54163 by major payers:
$271.50
$288.98
$322.45
$359.23
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 54163.
CPT 54163
5 of 25 sample ratesHigher to lower in this preview
Beltway Surgery Centers LLC
$8,705.00Published rateSummit Surgical Center, LLC
$2,595.00Published rateWillamette Surgery Center LLC
Willamette Surgery Center, P.C.
$1,947.00Published rateChevy Chase Asc LLC, Chevy Chase Endoscopy Center
$1,285.00Published rateDanville Polyclinic, Ltd, Danville Polyclinic Ltd Astc
Danville Polyclinic, Ltd.
$737.00Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 54163 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54163 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 54163 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 |
| 54163-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. |
| 54164-CPT | Moderate | Frenulotomy Of Penis |
| 54200-CPT | Low | Treatment For Plaque In Penis, Injection Of Medication In Or Near The Fibrous Tissue That Forms Inside The Penis With Peyronies Disease. The Medicine Eases The Abnormal Muscle Contraction. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 54163. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54163 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 54163) and we'll show you how you compare in 15 minutes or less.