CPT 54200 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 • 58 - Staged or related procedure during postoperative period • AG - Primary physician |
| Complexity Level | Low |
| CMS | $114.83 Physician Fee Schedule |
National average reimbursement for CPT 54200 by major payers:
$145.93
$146.45
$162.49
$192.16
| 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 54200 | ||||||
United | 54200 | $200.00 | 1497367262 - SNKS ENTERPRISES LLC, SOL VALLEY SURGERY CENTER | 364932587 - (AZ) SNKS ENTERPRISES LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54200 | $1136.00 | 1962435990 - NORTHERN MONMOUTH REGIONAL SURGERY CENTER LLC, CENTER FOR BONE AND JOINT SURGERY | 201026094 - (NJ) NORTHERN MONMOUTH REGIONAL SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54200 | $506.00 | 1821421256 - MONOCACY SURGERY CENTER LLC | 462861862 - (MD) MONOCACY SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54200 | $136.00 | 1104899855 - SOUTHFIELD ENDOSCOPY ASC LLC, GASTROINTESTINAL ENDOSCOPY CENTER | 943421929 | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54200 | $1096.00 | 1902204654 - DENVER SURGICENTER, LLC | 472340660 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54200 | $566.00 | 1942507488 - GA ENDOSCOPY CENTER, LLC | 273115800 - (GA) GA ENDOSCOPY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54200 | $383.00 | 1992706840 - AMBULATORY SURGERY CENTER OF BURLEY, LLC | 820502971 - (ID) AMBULATORY SURGERY CENTER OF BURLEY LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54200 | $527.00 | 1043874621 - BROWNSVILLE SURGICENTER, LLC | 825464594 - (TX) BROWNSVILLE SURGICENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54200 | $92.00 | 1497843825 - COMMONWEALTH ORTHOPAEDICS & REHABILITATION, PC | 540885859 - (VA) ORTHOVIRGINIA, INC. | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54200 | $1446.00 | 1275536328 - BELLAIRE OUTPATIENT SURGERY CENTER, LLP, BAYLOR SCOTT & WHITE SURGICARE - OAKMONT | 562297308 - (TX) BELLAIRE OUTPATIENT SURGERY CENTER LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54200 | $1446.00 | 1760912554 - BAYLOR SURGICARE AT BAYLOR PLANO, LLC, BAYLOR SCOTT & WHITE SURGICARE AT PLANO ALLIANCE | 813127185 - (TX) BAYLOR SURGICARE AT BAYLOR PLANO LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54200 | $553.00 | 1114265519 - PRECISION AMBULATORY SURGERY CENTER LLC | 461628556 - (CA) PRECISION AMBULATORY SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54200 | $531.00 | 1811433410 - OPHTHALMOLOGY SURGERY CENTER OF ORLANDO LLC, ORLANDO OPHTHALMOLOGY SURGERY CENTER | 814378043 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54200 | $574.00 | 1346693124 - VILLAGES ENDOSCOPY CENTER LLC | 813250494 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54200 | $688.00 | 1992796742 - SAN ANTONIO ENDOSCOPY, LP, SAN ANTONIO ENDOSCOPY CENTER | 202511329 - (TX) SAN ANTONIO ENDOSCOPY LP | TX | 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 54200 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54200 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 54200 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 |
|---|---|---|
| 54200-CPT | Low | Inject For Peyronie Disease |
| 54205-CPT | Moderate | Injec Procd-Peyrnie;Surg.Expos-Plaq |
| 54230-CPT | Low | Injec.Proced-Corpora Cavernosogrphy |
| 54324-CPT | High | One Stage Distal Hypospadias Repair (With Or Without Chordee Or Circumcision); With Urethroplasty By Local Skin Flaps (Eg Flip- Flap Prepucial Flap) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 54200. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54200 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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