CPT 54380 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 • 21 - Inpatient Hospital |
| Common Modifiers | • None • 82 - Assistant surgeon - no qualified resident • 62 - Co-Surgeons |
| Complexity Level | High |
| CMS | $777.93 Physician Fee Schedule |
National average reimbursement for CPT 54380 by major payers:
$1,039.55
$1,080.24
$1,125.64
$1,349.26
| 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 54380 | ||||||
United | 54380 | $2450.00 | 1306375837 - CENTRAL COAST CARDIOVASCULAR ASC LLC | 821736669 - (CA) CENTRAL COAST CARDIOVASCULAR ASC LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54380 | $3976.00 | 1780128553 - CAROLINAS ENDOSCOPY CENTER LLC | 814599818 - CAROLINAS ENDOSCOPY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54380 | $717.00 | 1033162631 - EYE SURGERY CENTER-NORTHLAND LLC | 201938574 - (MO) EYE SURGERY CENTERNORTHLAND LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54380 | $756.00 | 1407131949 - LEE SURGERY CENTER LLC | 453606333 - (OH) LEE SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54380 | $1283.00 | 1750414983 - ROCKLEDGE SURGERY CENTER, INC. | 522098503 - (MD) ROCKLEDGE SURGERY CENTER INC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54380 | $4600.00 | 1790945145 - MANSFIELD SURGICAL PLAZA LLC, MANSFIELD SURGERY CENTER | 271835675 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54380 | $3500.00 | 1184714214 - GAINESVILLE ENDOSCOPY CENTER, LLC | 10750801 - (GA) GAINESVILLE ENDOSCOPY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54380 | $2049.00 | 1760473425 - BECKLEY SURGERY CENTER, INC | 550764318 - (WV) BECKLEY SURGERY CENTER INC | WV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54380 | $2814.00 | 1053835058 - CEI PHYSICIANS PSC LLC, CVP SURGERY CENTER | 311473421 - CINCINNATI EYE INSTITUTE | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54380 | $614.00 | 1437232758 - SHADY GROVE REPRODUCTIVE SCIENCE CENTER PC, SGFC SURGERY CENTER | 208131466 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54380 | $2280.00 | 1336445873 - SAND LAKE SURGICENTER LLC, SAND LAKE SURGERY CENTER | 273787593 - (FL) SAND LAKE SURGICENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54380 | $691.00 | 1104894369 - VALLEY OUTPATIENT SURGICAL CENTER INC | 860585124 - (AZ) VALLEY OUTPATIENT SURGICAL CENTER INC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54380 | $5019.00 | 1356878052 - PAVILION SURGERY CENTER LLC | 814376492 - (CA) PAVILION SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54380 | $4633.00 | 1528339447 - CP SURGERY CENTER, LLC | 800776412 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54380 | $2839.00 | 1184680407 - OAK BROOK SURGICAL CENTRE INC. | 363317971 - (IL) OAKBROOK SURGICAL CENTRE, INC | IL | 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 54380 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54380 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 54380 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 |
|---|---|---|
| 54360-CPT | Moderate | Plastic Operation On Penis To Correct An |
| 54380-CPT | High | Repair Penis Espispadias |
| 54385-CPT | High | Plast.Op-Penis-Epispad.Dist-Ext.Sphinc; |
| 54405-CPT | High | Insertion Of Multi-Component, Inflatable Penile Prosthesis, Including Placement Of Pump, Cylinders, & Reservoir - Commercial Rn Review>=11/17/2021 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 54380. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54380 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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