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See a sample rate comparisonCPT 54164 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.
Frenulotomy Of Penis
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Male Genital System |
| Common Place of Service | 24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 59 - Distinct Procedural Service 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 54164 |
| Medicaid Fee Schedule | View Medicaid rates for 54164 |
National average reimbursement for CPT 54164 by major payers:
$254.59
$254.96
$273.82
$318.57
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CPT 54164
5 of 25 sample ratesHigher to lower in this preview
Wisconsin Surgery Center LLC
Wisconsin Surgery Center, LLC
$7,810.00Published rateSummit Surgical Center, LLC
$2,595.00Published rateNazareth Endoscopy Center, LLC
Nazareth Endoscopy Center LLC
$2,250.00Published ratePhysicians Eye Surgery Center, Inc
Physicians Eye Surgery Center Inc
$1,078.00Published rateThe Rome Endoscopy Center
$525.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 54164 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54164 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 54164 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 |
|---|---|---|
| 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. |
| 54308-CPT | Moderate | Urethroplasty For Second Stage Hypospadias Rpair (Inclu Urinary, Urethroplasty For Second Stage Hypospadias Repair (Including Urinary D |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 54164. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54164 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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