CPT 54304 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 | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • SG - Scene to Hospital ESRD facility • 51 - Multiple procedures |
| Complexity Level | Moderate |
| CMS | $727.15 Physician Fee Schedule |
National average reimbursement for CPT 54304 by major payers:
$929.69
$1,008.21
$1,082.14
$1,258.60
| 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 54304 | ||||||
United | 54304 | $8825.00 | 1124492541 - MEMORIAL HERMANN SURGERY CENTER PINECROFT, LLC | 371796296 - (TX) MEMORIAL HERMANN SURGERY CENTER PINECROFT LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54304 | $5433.00 | 1114126596 - CORAL RIDGE OUTPATIENT CENTER LLC, CORAL RIDGE OUTPATIENT CENTER | 205429299 - (FL) CORAL RIDGE OUTPATIENT CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54304 | $2200.00 | 1225036601 - TALLGRASS SURGICAL CENTER, LLC | 481243206 - (KS) TALLGRASS SURGICAL CENTER, LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54304 | $3901.00 | 1962879932 - GUILFORD SURGERY CENTER LLC | 473071064 - (CT) GUILFORD SURGERY CENTER | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54304 | $8238.00 | 1902844426 - SOUTH ARLINGTON SURGICAL PROVIDERS, LLC, SAME DAY SURGICARE | 752723958 - (TX) SOUTH ARLINGTON SURGICAL PROVIDERS LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54304 | $5415.00 | 1609907211 - SHREWSBURY SURGERY CENTER, LLC, SHREWSBURY SURGERY CENTER | 223651945 - (NJ) SHREWSBURY SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54304 | $1599.00 | 1982676227 - THE PALMETTO ASC, LLC, THE PALMETTO SURGERY CENTER | 621647406 - (FL) THE PALMETTO SURGERY CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54304 | $6506.00 | 1609274505 - BAY AREA SURGICAL SPECIALIST SERVICES, LLC | 471556346 - (CA) BAY AREA SURGICAL SPECIALIST SERVICES LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54304 | $11291.00 | 1811172729 - INDIANA ENDOSCOPY CENTERS LLC, INDIANA ENDOSCOPY CENTER WEST | 208398421 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54304 | $625.00 | 1639105455 - ENDOSURG OUTPATIENT CENTER LLC | 593678998 - (FL) ENDOSURG OUTPATIENT CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54304 | $16929.00 | 1538292990 - TEXAS HEALTH HARRIS METHODIST HOSPITAL FORT WORTH | 752678857 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHWEST FORT WORTH | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54304 | $2801.00 | 1184782203 - EASTERN OREGON REGIONAL SURGERY | 710881667 - (OR) EASTERN OREGON REGIONAL SURGERY | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54304 | $860.00 | 1407131949 - LEE SURGERY CENTER LLC | 453606333 - (OH) LEE SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54304 | $1320.00 | 1952945156 - PHYSICIANS WEST SURGICENTER, LLC | 843452204 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54304 | $3067.00 | 1720011042 - PREMIER ORTHOPAEDIC SURGERY CENTER, LLC | 352433859 | TN | 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 54304 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54304 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 54304 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 |
|---|---|---|
| 54300-CPT | Moderate | Plastic Operation Of Penis For Straightening Of Chordee (Eg, Hypospadias), With Or Without Mobilization Of Urethra; |
| 54304-CPT | Moderate | Plastic Operation On Penis For Correction Of Chordee Or For First Stage Hypospadias Repair With Or Without Transplantation Of Prepuce And/Or Skin Flaps |
| 54322-CPT | Moderate | One Stage Distal Hypospadias Repair (With Or Without Chordee Or Circumcision); With Simple Meatal Advancement (Eg Magpi V- Flap) |
| 54324-CPT | High | One Stage Distal Hypospadias Repair (With Or Without Chordee Or Circumcision); With Urethroplasty By Local Skin Flaps (Eg Flip- Flap Prepucial Flap) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 54304. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54304 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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