CPT 54328 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 • AS - PA/NP/CNS assistant at surgery • GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 54328 |
National average reimbursement for CPT 54328 by major payers:
$1,193.23
$1,257.27
$1,339.71
$1,569.98
| 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 54328 | ||||||
United | 54328 | $6506.00 | 1659793040 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54328 | $1556.00 | 1164601696 - SALVATORE DIMERCURIO MD PA | 521833726 - (MD) SALVATORE DIMERCURIO, M.D., P.A. | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54328 | $2489.00 | 1609375682 - LUTHERVILLE SURGERY CENTER, LLC | 823355711 - (MD) LUTHERVILLE SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54328 | $4234.00 | 1184689010 - PARK CITIES SURGERY CENTER, LLC, PARK CITIES SURGERY CENTER | 562357079 - (TX) PARK CITIES SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54328 | $1361.00 | 1851354377 - MANATEE SURGICARE LTD | 752367622 - (FL) MANATEE SURGICARE LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54328 | $1509.00 | 1649911470 - ST. PETERSBURG OUTPATIENT SURGERY CENTER, LLC | 842007777 - (FL) ST PETERSBURG OUTPATIENT SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54328 | $1300.00 | 1780604694 - CLEARVIEW SURGERY CENTER INC | 202828714 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54328 | $1813.00 | 1154440972 - SEBASTOPOL ASC, L.P. | 621560936 - (CA) SEBASTOPOL ASC LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54328 | $8055.00 | 1346403854 - THE EMORY CLINIC INC, EMORY ORTHOPAEDIC SURGERY CENTER | 582030692 - EMORY UNIVERSITY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54328 | $1500.00 | 1528297140 - ISPM ASC AT COVINGTON, LLC | 264485600 - (GA) ISPM ASC AT COVINGTON LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54328 | $1040.00 | 1669720439 - OCALA SURGICAL CENTER, OCALA SURGICAL CENTER, LLC | 842579958 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54328 | $5433.00 | 1831420694 - TITUSVILLE CENTER FOR SURGICAL EXCELLENCE LLC | 263531997 - (FL) TITUSVILLE CENTER FOR SURGICAL | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54328 | $627.00 | 1124092945 - ROCKLEDGE FL ENDOSCOPY ASC LLC, SPACE COAST ENDOSCOPY CENTER | 200073131 - (FL) ROCKLEDGE FL ENDOSCOPY ASC LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54328 | $1320.00 | 1861702359 - INLAND OUTPATIENT SURGERY CENTER, INC. | 900621582 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54328 | $11291.00 | 1306351887 - BELTWAY SURGERY CENTERS, LLC, MERIDIAN SOUTH SURGERY CENTER | 352072586 | IN | 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 54328 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54328 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 54328 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 |
|---|---|---|
| 54326-CPT | High | One Stage Distal Hypospadias Repair (With Or Without Chordee Or Circumcision); With Urethroplasty By Local Skin Flaps And Mobilization Of Urethra |
| 54328-CPT | High | One Stage Distal Hypospadias Repair (With Or Without Chordee Or Circumcision); With Extensive Dissection To Correct Chordee And Urethroplasty With Local Skin Flaps Skin Graft Patch And/Or Island Flap |
| 54332-CPT | High | One Stage Proximal Penile Or Penoscrotal Hypospadias Repair Requiring Extensive Dissection To Correct Chordee And Urethroplasty By Use Of Skin Graft Tube And/Or Island Flap |
| 54336-CPT | High | One Stage Perineal Hypospadias Repair Requiring Extensive Dissection To Correct Chordee And Urethroplasty By Use Of Skin Graft Tube And/Or 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 54328. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54328 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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