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 |
| Medicare Fee Schedule | View Medicare rates for 54250 |
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 | $818.00 | 1114924685 - SOUTH KANSAS CITY SURGICAL CENTER, LC, SOUTH KANSAS CITY SURGICENTER | 202181884 - (KS) SOUTH KANSAS CITY SURGICAL CENTER, LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54250 | $111.00 | 1942414750 - HAMILTON EYE INSTITUTE SURGERY CENTER, L.P. | 202873438 - (TN) HAMILTON EYE INSTITUTE SURGERY CENTER LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54250 | $1708.00 | 1780691386 - ORTHOPAEDIC SPECIALISTS SURGI-CENTER, LLC | 201407302 - (DE) ORTHOPAEDIC SPECIALISTS SURGICENTER LLC | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54250 | $137.00 | 1184699241 - SAN LUIS OBISPO CA ENDOSCOPY ASC LP, TEMPLETON ENDOSCOPY CENTER | 201965605 - (CA) SAN LUIS OBISPO CA ENDOSCOPY ASC LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54250 | $118.00 | 1588603351 - PHYSICIAN'S DAY SURGERY CENTER | 710623198 | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54250 | $260.00 | 1306851902 - SPECIALTY SURGICAL CENTER OF IRVINE LP | 571149464 - (CA) SPECIALTY SURGICAL CENTER OF IRVINE, LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54250 | $2321.00 | 1619971082 - KU MEDWEST AMBULATORY SURGERY CENTER, LLC | 20664568 - (KS) KU MEDWEST AMBULATORY SURGERY CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54250 | $9.39 | 1124526611 - KATHLEEN QUATRO | 350593390 - DEACONESS HOSPITAL INC | KY | Family Nurse Practitioner (363LF0000X) |
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 | $325.00 | 1427144336 - PORTLAND CLINIC, THE PORTLAND CLINIC SURGICAL CENTER | 930400952 - (OR) THE PORTLAND CLINIC LLP | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54250 | $200.00 | 1316326242 - ST. MINA INTERVENTIONAL PAIN CENTER, INC, MINA PAIN CENTER | 473803677 - (OH) ST MINA INTERVENTIONAL PAIN CENTER INC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54250 | $970.00 | 1952720674 - BOUNTIFUL SURGERY CENTER, LLC | 364581088 | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54250 | $200.00 | 1356954648 - ASC OF THE HEART INSTITUTE | 823433427 - (NM) ASC OF THE HEART INSTITUTE | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54250 | $304.00 | 1508912262 - WAUKEGAN ILLINOIS HOSPITAL COMPANY LLC, VISTA SURGERY CENTER | 203978521 | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54250 | $35.00 | 1306005343 - DIGESTIVE HEALTH SPECIALISTS, PA | 561242980 - (NC) DIGESTIVE HEALTH SPECIALISTS, P.A. | NC | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 54250) and we'll show you how you compare in 15 minutes or less.