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See a sample rate comparisonCPT 54205 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.
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.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Male Genital System |
| Common Place of Service | 24 - Ambulatory Surgical Center 11 - Office |
| Common Modifiers | None 59 - Distinct Procedural Service 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 54205 |
| Medicaid Fee Schedule | View Medicaid rates for 54205 |
National average reimbursement for CPT 54205 by major payers:
$674.54
$710.59
$730.64
$875.06
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CPT 54205
5 of 25 sample ratesHigher to lower in this preview
Northshore Regional Medical Center Dba The Surgery Suite, The Surgery Suite
Ochsner Clinic Foundation
$11,615.00Published rateMount Pleasant Outpatient Surgery Center LLC
$3,842.00Published rateAtlas Surgery Center, LLC, Atlas Surgery Center, LLC
Atlas Surgery Center LLC
$1,980.00Published rateWaterside Ambulatory Surgical Center LLC
Waterside Ambulatory Surgical Ce
$1,211.00Published rateBarnet Dulaney Perkins Eye Center, PC, American Vision Partners
Barnet Dulaney Perkins Eye Center PLLC
$626.00Published rate
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See a sample payer proposalCPT 54205 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54205 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 54205 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 | 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. |
| 54205-CPT | Moderate | 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. |
| 54220-CPT | Moderate | Release Of Prolonged Erection, One Of Various Surgeries Designed To Correct Uncontrolled Or Abnormal Blood Flow To The Penis Thus Releasing A Prolonged Erection (Priapism). |
| 54235-CPT | Low | Inject Of Corpora Cavernosa W/ Pharmacolog Agnt(S) (Eg Papave, Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Eg Papave |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 54205. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54205 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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