CPT 54340 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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • AG - Primary physician • 51 - Multiple procedures |
| Complexity Level | Moderate |
National average reimbursement for CPT 54340 by major payers:
$716.91
$762.96
$817.78
$959.00
| 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 54340 | ||||||
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CPT 54340 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54340 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 54340 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 |
|---|---|---|
| 54336 | High | One Stage Perineal Hypospadias Repair Requiring Extensive Dissection To Correct Chordee And Urethroplasty By Use Of Skin Graft Tube And/Or Island Flap |
| 54340 | Moderate | Repair Of Hypospadias Complication(S) (Ie Fistula Stricture Diverticula); By Closure Incision Or Excision Simple (Desc Rvsd 1/1/22) |
| 54344 | High | Repair Of Hypospadias Complications (Ie Fistula Stricture Diverticula); Requiring Mobilization Ofskin Flaps And Urethroplasty With Flap Or Patch Graft (Desc Rvsd 1/1/22) |
| 54348 | High | Repair Of Hypospadias Complication(S) (Ie Fistula Stricture Diverticula); Requiring Extensive Dissection And Urethroplasty With Flap Patch Or Tubed Graft (Includes Urinary Diversion) (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 54340. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54340 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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Medicare Reimbursement Lookup Tool
Medicare localities are geographic regions used to adjust reimbursement rates based on local costs. Rates vary by locality to reflect differences in wages, rent, and other expenses. Sign up to see commercial rates (United/BCBS/Cigna/Aetna)
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| Year | Billing Code | Locality | Non-Facility Fee | Facility Fee |
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