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 54231 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.
Erectile Study With Treatment, Study Of Blood Pressure Variance In The Penis Including Injection Of Medication To Treat Erectile Dysfunction.
| 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 51 - Multiple procedures 79 - Unrelated procedure - postop period TC - Technical component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 54231 |
| Medicaid Fee Schedule | View Medicaid rates for 54231 |
National average reimbursement for CPT 54231 by major payers:
$182.41
$188.08
$195.21
$232.23
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 54231.
CPT 54231
5 of 25 sample ratesHigher to lower in this preview
Marin Health Ventures, LLC, Marin Specialty Surgery Center
Marin Health Ventures, Inc. Dba Marin Specialty Surgery Center
$2,574.00Published rateHanover Nj Endoscopy Asc LLC, Hanover Endoscopy Center
Hanover Nj Endoscopy Asc LLC
$1,278.00Published rateDoctors Outpatient Surgery Center LLC, Doctors Outpatient Surgery Center
Doctors Outpatient Surgery Center, LLC
$900.00Published rateCrestview Hills Surgery Center, PLLC, Ican
Michael Fletcher Md PLLC
$725.00Published rateG.I.Endoscopy Center
Giendoscopy Center
$390.00Published 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 54231 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54231 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 54231 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 |
|---|---|---|
| 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). |
| 54230-CPT | Low | Injec.Proced-Corpora Cavernosogrphy |
| 54231-CPT | Low | Erectile Study With Treatment, Study Of Blood Pressure Variance In The Penis Including Injection Of Medication To Treat Erectile Dysfunction. |
| 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 54231. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54231 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 54231) and we'll show you how you compare in 15 minutes or less.