CPT 54312 Fee Schedule
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.
| 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 |
National average reimbursement for CPT 54312 by major payers:
$1,030.34
$1,108.54
$1,161.62
$1,381.96
| 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 54312 | ||||||
United | 54312 | $1237.00 | 1215263082 - NCBH OUTPATIENT ENDOSCOPY CENTER, L.L.C., WFUBMC ENDOSCOPY CENTER | 270668137 - (NC) NCBH OUTPATIENT ENDOSCOPY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54312 | $1122.00 | 1497084982 - WAKE ENDOSCOPY CENTER, LLC | 611578919 | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54312 | $799.00 | 1457320962 - FOOT AND ANKLE CENTER AT THE BURKLAND MEDICAL CENTER INC. | 522160415 - (MD) FOOT AND ANKLE CENTER AT THE BURKLAND MEDICAL CENTER INC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54312 | $1320.00 | 1083659866 - ORTHOPAEDIC SURGERY CENTER OF SAN ANTONIO LP, FOUNDATION SURGERY AFFILIATE OF SAN ANTONIO LP | 742976746 - (TX) ORTHOPAEDIC SURGERY CENTER OF SAN ANTONIO LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54312 | $2166.00 | 1518004696 - CENTURY CITY ENDOSCOPY, LLC | 954754975 - (CA) CENTURY CITY ENDOSCOPY LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54312 | $1702.00 | 1235255605 - EAGLE EYE SURGERY AND LASER CENTER LLC, EAGLE EYE SURGERY & LASER CENTER | 820521864 - (ID) EAGLE EYE SURGERY AND LASER CENTER LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54312 | $10263.29 | 1649392242 - ST. CLAIR MEMORIAL HOSPITAL | 251010303 - (PA) ST CLAIR HEALTH CORPORATION | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54312 | $1471.68 | 1114946852 - CHRISTOPHER STEWART | 350593390 - DEACONESS HOSPITAL INC | IN | Certified Registered Nurse Anesthetist (367500000X) |
United | 54312 | $3500.00 | 1366444929 - EAST WEST SURGERY CENTER LP | 621797897 - (GA) EAST WEST SURGERY CENTER LP | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54312 | $1414.00 | 1295948339 - WILMINGTON GASTROENTEROLOGY ENDOSCOPY CENTER, INC | 463956703 - (NC) WILMINGTON GASTROENTEROLOGY ENDOSCOPY CENTER INC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54312 | $3500.00 | 1891257473 - WESTGATE SURGERY CENTER, LLC, WESTGATE SURGERY CENTER | 352651945 - (AZ) WESTGATE SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54312 | $3384.00 | 1023070026 - TOMS RIVER SURGERY CENTER, LLC, TOMS RIVER SURGERY CENTER | 752854783 - (NJ) TOMS RIVER SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54312 | $3570.00 | 1720085277 - ROSWELL SURGERY CENTER LLC, ROSWELL SURGERY CENTER | 582577112 - (GA) ROSWELL SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54312 | $764.00 | 1306283957 - MICHIGAN ENDOSCOPY CENTER AT PROVIDENCE PARK | 455323684 - (MI) MICHIGAN ENDOSCOPY CENTER AT PROVIDENCE PARK | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54312 | $1320.00 | 1710081443 - VENTURA ENDOSCOPY CENTER LLC | 680543503 - (CA) VENTURA ENDOSCOPY CENTER LLC | CA | 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 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 | Rep Hypospadias 2nd Stage < 3 Cm |
| 54312-CPT | High | Urethroplas-2nd Stg Hypospd;Ov.3 Cm |
| 54316-CPT | High | Urethroplasty For Second Stage Hypospadias Repair (Including Urinary Diversion) With Free Skin Graft Obtained From Site Other Than Genitalia |
| 54340-CPT | Moderate | Repair Of Hypospadias Complication(S) (Ie Fistula Stricture Diverticula); By Closure Incision Or Excision Simple (Desc Rvsd 1/1/22) |
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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