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See a sample rate comparisonCPT 54312 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Urethroplasty For Second Stage Hypospadias Rpair (Inclu Urinary, Urethroplasty For Second Stage Hypospadias Repair (Including Urinary D
| 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 82 - Assistant surgeon - no qualified resident 22 - Increased Procedural Services |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 54312 |
| Medicaid Fee Schedule | View Medicaid rates for 54312 |
National average reimbursement for CPT 54312 by major payers:
$1,030.34
$1,108.54
$1,161.62
$1,349.29
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CPT 54312
5 of 25 sample ratesHigher to lower in this preview
St. Clair Memorial Hospital
St Clair Health Corporation
$10,263.29Published rateToms River Surgery Center, LLC, Toms River Surgery Center
Toms River Surgery Center LLC
$3,384.00Published rateEagle Eye Surgery And Laser Center LLC, Eagle Eye Surgery & Laser Center
Eagle Eye Surgery And Laser Center LLC
$1,702.00Published rateVentura Endoscopy Center LLC
$1,320.00Published rateMountain West Derm
$750.00Published rate
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See a sample payer proposalCPT 54312 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54312 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 54312 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 |
|---|---|---|
| 54308-CPT | Moderate | Urethroplasty For Second Stage Hypospadias Rpair (Inclu Urinary, Urethroplasty For Second Stage Hypospadias Repair (Including Urinary D |
| 54312-CPT | High | Urethroplasty For Second Stage Hypospadias Rpair (Inclu Urinary, Urethroplasty For Second Stage Hypospadias Repair (Including Urinary D |
| 54316-CPT | High | Urethroplasty For Second Stage, Urethroplasty For Second Stage Hypospadias Repair (Includingurinary Diversion) With Free Skin Graft Obtained From Site Other Than Genitalia |
| 54340-CPT | Moderate | Repair Urinary Complication, Surgery To Repair A Complication Of Hypospadias A Condition Present Since Birth Where The Urine Exits The Underside Of The Penis. The Repair May Involve A Skin Graft And Removal Of Scar Tissue Or Connective Tissue. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 54312. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54312 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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