CPT 54250 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 • 24 - Ambulatory Surgical Center • 22 - On Campus Outpatient Hospital • 23 - Emergency Room |
| Common Modifiers | • None • 50 - Bilateral Procedure • 26 - Professional component |
| Complexity Level | Low |
| CMS | $14.23 Physician Fee Schedule |
National average reimbursement for CPT 54250 by major payers:
$151.87
$164.85
$167.14
$206.13
| 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 54250 | ||||||
United | 54250 | $1125.00 | 1902401748 - LANDMARK SURGICAL SUITES, LLC | 851130696 - (IN) LANDMARK SURGICAL SUITES LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54250 | $825.00 | 1558672626 - CALIFORNIA COLON AND RECTAL CANCER SCREENING CENTER LLC, CALIFORNIA COLON ANDD RECTAL CANCER SCREENING CENTER LLC | 273443611 - (CA) CALIFORNIA COLON AND RECTAL CANCER SCREENING CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54250 | $359.00 | 1376595421 - OTAY LAKES SURGERY CENTER, LLC | 200794766 - (CA) OTAY LAKES SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54250 | $9.39 | 1124526611 - KATHLEEN QUATRO | 350593390 - DEACONESS HOSPITAL INC | KY | Family Nurse Practitioner (363LF0000X) |
United | 54250 | $91.50 | 1326057126 - SCOTT TRITT | 350593390 - DEACONESS HOSPITAL INC | MI | Certified Registered Nurse Anesthetist (367500000X) |
United | 54250 | $350.00 | 1265431670 - AUBURN SURGERY CENTER INC. | 431937843 - (MO) AUBURN SURGERY CENTER INC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54250 | $75.00 | 1336324045 - MCCANDLESS ENDOSCOPY CENTER, LLC | 261284448 - (PA) MCCANDLESS ENDOSCOPY CENTER | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54250 | $58.00 | 1346331329 - PHYSICIANS EYE SURGERY CENTER LLC, PHYSICIANS' EYE SURGERY CENTER | 571116347 - (SC) PHYSICIANS EYE SURGERY CENTER | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54250 | $396.00 | 1770731853 - SHAWNEE MISSION PRAIRIE STAR SURGERY CENTER LLC, ADVENTHEALTH SURGERY CENTER LENEXA | 364634843 - (KS) SHAWNEE MISSION PRAIRIE STAR SURGERY CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54250 | $1042.00 | 1992713010 - NORTHFIELD SURGICAL CENTER LLC, NORTHFIELD SURGICAL CENTER | 223509801 - (NJ) NORTHFIELD SURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54250 | $123.00 | 1174233522 - THOMAS EYE SURGERY CENTER OF FAYETTE | 881476592 - (GA) THOMAS EYE SURGERY CENTER OF FAYETTE | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54250 | $90.00 | 1467089599 - CONWAY AMBULATORY SURGERY CENTER, LLC | 832516939 - (AR) CONWAY AMBULATORY SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54250 | $823.00 | 1891730644 - LAKEWALK SURGERY CENTER, INC. | 411791860 - (MN) LAKEWALK SURGERY CENTER INC. | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54250 | $212.00 | 1164976478 - FRANCISCAN MEDICAL GROUP, THE DOCTORS CLINIC AMBULATORY SURGICAL CENTER, A PART OF THE FRANCISCA | 911939739 - FRANCISCAN MEDICAL GROUP | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54250 | $100.00 | 1205872108 - THE SURGERY & ENDOSCOPY CENTER LLC | 43747286 - (FL) THE SURGERY ENDOSCOPY CENTER LLC | FL | 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 54250 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54250 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 54250 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 |
| 54408-CPT | Moderate | Repair Of Component(S) Of A Multi-Component, Inflatable Penile Prosthesis |
| 54410-CPT | High | Removal & Replacement Of All Component Of Multi-Component, Inflatable Penile Prosthesis At Same Operative Session - Rn Review<6/20/2013 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 54250. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54250 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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