Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 54316 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, Urethroplasty For Second Stage Hypospadias Repair (Includingurinary Diversion) With Free Skin Graft Obtained From Site Other Than Genitalia
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Male Genital System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | None 82 - Assistant surgeon - no qualified resident 22 - Increased Procedural Services |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 54316 |
| Medicaid Fee Schedule | View Medicaid rates for 54316 |
National average reimbursement for CPT 54316 by major payers:
$1,315.00
$1,345.68
$1,386.31
$1,634.61
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 54316.
CPT 54316
5 of 25 sample ratesHigher to lower in this preview
Disc Surgery Center At Marina Del Rey LLC
$12,000.00Published rateUcsd Center For Surgery Of Encinitas, L.P.
$3,353.00Published rateAbilene Eye Asc Lp, Abilene Cataract And Refractive Surgery Center
Abilene Eye Asc Lp
$1,834.00Published rateLegent Outpatient Surgery Singing Hills, LLC, Legent Outpatient Surgery Singing Hills
Legent Outpatient Surgery Singing Hills LLC
$1,320.00Published ratePhysicians' Surgery Center, LLC
Physicians Surgery Center, L.L.C.
$815.00Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 54316 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54316 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 54316 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 |
| 54328-CPT | High | 1-Stage Distal Hypospadias Rep, 1-Stage Distal Hypospadias Repair (With Or Withoutchordee Or Circumcision) With Extensive Dissecti On To Correct Chordee And Urethroplasty With Localskin Flaps Skin Graft Patch Andor Island Flap |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 54316. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54316 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 54316) and we'll show you how you compare in 15 minutes or less.