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 |
| CMS | $908.94 Physician Fee Schedule |
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 | $3318.00 | 1730571118 - MEDSTAR MEDICAL GROUP | 462691028 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54328 | $2919.00 | 1417286428 - ALLIANCE SURGICAL CENTER LLC | 271367127 - (FL) ALLIANCE SURGICAL CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54328 | $1320.00 | 1205853041 - EUCLID ENDOSCOPY CENTER, LP | 203197449 - (CA) EUCLID ENDOSCOPY CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54328 | $7770.00 | 1598096802 - MEMORIAL HERMANN SURGERY CENTER MEMORIAL CITY LLC, MEMORIAL HERMANN MEMORIAL VILLAGE SURGERY CENTER | 264276930 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54328 | $8238.00 | 1487399168 - WILLOW PARK ENDOSCOPY CENTER, LLC | 881643733 - (TX) WILLOW PARK ENDOSCOPY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54328 | $766.00 | 1619517539 - MOUNTAIN WEST DERM | 813253496 | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54328 | $2164.00 | 1013048461 - GASTROENTEROLOGY DIAGNOSTIC CENTER MEDICAL GROUP, A PROFESSIONAL, GASTROENTEROLOGY DIAGNOSTIC CENTER | 953921090 - (CA) GASTROENTEROLOGY DIAGNOSTIC CENTER MEDICAL GROUP A PROFESSIONAL | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54328 | $5249.00 | 1104298009 - RED CEDAR SURGERY CENTER, LLC, RED CEDAR SURGERY CENTER, PLLC | 472947364 - (MI) RED CEDAR SURGERY CENTER, PLLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54328 | $1320.00 | 1255351714 - FASA FAMILY WELLNESS, PLLC | 472330607 - (WA) FASA FAMILY WELLNESS PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54328 | $3200.00 | 1053846592 - EASTSIDE ENDOSCOPY CENTER LLC | 810759895 - (GA) EASTSIDE ENDOSCOPY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54328 | $1168.00 | 1134499684 - CHILDRENS SURGERY CENTER OF MALVERN, LLC | 452608984 - (PA) CHILDRENS SURGERY CENTER OF MALVERN LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54328 | $1320.00 | 1699702050 - VIRGINIA MASON MEDICAL CENTER, VIRGINIA MASON BELLEVUE ASC | 910565539 - (WA) VIRGINIA MASON MEDICAL CENTER | WA | 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 | $3379.00 | 1669437497 - CASCADE SURGICENTER, LLC | 731677879 - (OR) CASCADE SURGICENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54328 | $5020.00 | 1588260343 - ADVENTHEALTH SURGERY CENTER WELLSWOOD LLC, ADVENTHEALTH SURGERY CENTER WELLSWOOD | 854111089 - (FL) ADVENTHEALTH SURGERY CENTER WELLSWOOD LLC | FL | 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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