CPT 54318 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 • 21 - Inpatient Hospital |
| Common Modifiers | • None • AG - Primary physician • 82 - Assistant surgeon - no qualified resident |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 54318 |
National average reimbursement for CPT 54318 by major payers:
$896.12
$953.26
$984.81
$1,195.45
| 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 54318 | ||||||
United | 54318 | $2110.00 | 1245297662 - WOODLAND SURGERY CENTER LLC | 391998961 - (WI) WOODLAND SURGERY CENTER, LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54318 | $1475.00 | 1700822335 - OLIVER STREET DERMATOLOGY ASC LLC, DERMATOLOGY SURGERY CENTER | 461320839 - (TX) OLIVER STREET DERMATOLOGY ASC LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54318 | $1300.00 | 1326379967 - WEIR ASC, LLC, SOUTHWEST EYE SURGERY CENTER | 271659546 - (OK) WEIR ASC LLC | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54318 | $1469.00 | 1043246077 - DUTCHESS AMBULATORY SURGICAL CENTER | 141803011 - (NY) DUTCHESS AMBULATORY SURGICAL CENTER | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54318 | $5278.00 | 1184900102 - METROPOLITAN NEW JERSEY, LLC, METROPOLITAN SURGERY CENTER | 453003521 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54318 | $1804.00 | 1801457478 - DIALYSIS ACCESS CENTER, LLC | 834488032 - (OH) DIALYSIS ACCESS CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54318 | $3500.00 | 1730175159 - CHARLOTTE ENDOSCOPIC SURGERY CENTER LLC, CHARLOTTE SURGERY CENTER | 651071112 - (FL) CHARLOTTE ENDOSCOPIC SURGERY CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54318 | $2832.00 | 1073908604 - ADVANCED SURGICAL GROUP, INC. | 464709919 - (CA) ADVANCED SURGICAL GROUP INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54318 | $919.00 | 1447218433 - LIBERTY EYE SURGICAL CENTER LLC | 200054137 - (PA) LIBERTY EYE SURGICAL CENTER, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54318 | $978.00 | 1487094058 - COMPREHENSIVE PAIN CENTER FOR SURGERY, FOUNTAINS SPECIALTY SURGICAL CENTER | 460896509 - (MS) COMPREHENSIVE PAIN CENTER FOR SURGERY | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54318 | $1924.00 | 1659409241 - EYE SURGERY CENTER, LOREN BARRUS & PAUL SCHULTZ PTRS | 931126853 - (OR) EYE SURGERY CENTER | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54318 | $3353.00 | 1083912745 - RED ROCKS SURGERY CENTERS, LLC | 271095323 - (CO) RED ROCKS SURGERY CENTERS LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54318 | $5772.00 | 1427017987 - BAPTIST SURGERY CENTER LP, BAPTIST AMBULATORY SURGERY CENTER | 621672473 - (TN) BAPTIST SURGERY CENTER LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54318 | $3623.00 | 1396174454 - SURGERY CENTER OF SCOTTSDALE LLC | 731553441 - (AZ) SURGERY CENTER OF SCOTTSDALE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54318 | $918.00 | 1861449571 - KIRURGS, LLC, SURGEONS' SURGICAL CENTER | 522018568 - (MD) SURGEONS SURGICAL CENTER, LLC | MD | 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 54318 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54318 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 54318 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 |
|---|---|---|
| 54318-CPT | Moderate | Urethroplasty-3rd Stage Hypospadias |
| 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) |
| 54326-CPT | High | One Stage Distal Hypospadias Repair (With Or Without Chordee Or Circumcision); With Urethroplasty By Local Skin Flaps And Mobilization Of Urethra |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 54318. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54318 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 54318) and we'll show you how you compare in 15 minutes or less.