CPT 54240 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 • 26 - Professional component • 59 - Distinct Procedural Service |
| Complexity Level | Low |
| CMS | $43.34 Physician Fee Schedule |
National average reimbursement for CPT 54240 by major payers:
$123.63
$135.61
$141.39
$176.51
| 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 54240 | ||||||
United | 54240 | $1979.00 | 1497244149 - HOSPITAL FOR SPECIAL SURGERY WEST SIDE AMBULATORY SURGERY CENTER, LLC, HSS WEST SIDE ASC, LLC | 814351390 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54240 | $111.00 | 1831116698 - LASER AND OUTPATIENT SURGERY CENTER LLC | 201098451 - (FL) LASER AND OUTPATIENT SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54240 | $168.71 | 1225014657 - CAROLINA RADIOLOGY ASSOCIATES LLC | 571049603 - (SC) CAROLINA RADIOLOGY ASSOCIATES, LLC | SC | Diagnostic Radiology Physician (2085R0202X) |
United | 54240 | $158.00 | 1104896422 - NORTH IDAHO PAIN CENTER LLC | 203305236 | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54240 | $200.00 | 1497776553 - ALPINE SURGERY CENTER LLC | 204038061 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54240 | $574.00 | 1255577045 - MAPLE LAWN SURGERY CENTER | 262739529 - (MD) MAPLE LAWN SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54240 | $154.00 | 1881850386 - THE CORVALLIS CLINIC PC | 931221257 - (OR) THE CORVALLIS CLINIC, P.C. | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54240 | $531.00 | 1811433410 - OPHTHALMOLOGY SURGERY CENTER OF ORLANDO LLC, ORLANDO OPHTHALMOLOGY SURGERY CENTER | 814378043 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54240 | $531.00 | 1891253035 - ADVANCED CENTER FOR SURGERY, THE ADVANCED CENTER FOR SURGERY | 611917634 - (FL) ADVANCED CENTER FOR SURGERY | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54240 | $403.00 | 1356099147 - HOPCO FLAGSTAFF ASC HOLDINGS, LLC, ELEVATION SURGERY CENTER | 851224752 - (AZ) HOPCO FLAGSTAFF ASC HOLDINGS LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54240 | $555.00 | 1851950281 - YUMA ADVANCED SURGICAL SUITES LLC | 833076801 - (AZ) YUMA ADVANCED SURGICAL SUITES, LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54240 | $51.00 | 1679566228 - AMBULATORY FOOT AND ANKLE CENTER, INC. | 521910756 - (MD) AMBULATORY FOOT AND ANKLE CENTER INC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54240 | $110.00 | 1215926993 - NORTH RIVER SURGICAL CENTER, LLC, NORTH RIVER SURGICAL CENTER, INC. | 201788603 | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54240 | $110.84 | 1225014657 - CAROLINA RADIOLOGY ASSOCIATES LLC | 571049603 - (SC) CAROLINA RADIOLOGY ASSOCIATES, LLC | SC | Diagnostic Radiology Physician (2085R0202X) |
United | 54240 | $281.00 | 1134183056 - TOPEKA SURGERY CENTER | 364500418 | KS | 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 54240 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54240 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 54240 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 |
|---|---|---|
| 54240-CPT | Low | Penile Plethysmography |
| 54250-CPT | Low | Nocturnal Penile Tumescence Test |
| 54401-CPT | Moderate | Insert Prosthes Penis-Inflatable |
| 54405-CPT | High | Insertion Of Multi-Component, Inflatable Penile Prosthesis, Including Placement Of Pump, Cylinders, & Reservoir - Commercial Rn Review>=11/17/2021 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 54240. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54240 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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