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 |
| Medicare Fee Schedule | View Medicare rates for 54380 |
National average reimbursement for CPT 54380 by major payers:
$1,039.55
$1,080.24
$1,125.64
$1,316.43
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 54380 | $3500.00 | 1184714214 - GAINESVILLE ENDOSCOPY CENTER, LLC | 10750801 - (GA) GAINESVILLE ENDOSCOPY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54380 | $1850.00 | 1043426950 - HOSPITAL DRIVE SURGERY CENTER, LLC | 770516196 - (CA) HOSPITAL DRIVE SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54380 | $1500.00 | 1316233612 - CPMSC CARROLLTON | 274203105 - (GA) CPMSC CARROLLTON | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54380 | $5843.00 | 1619974219 - ST. JOSEPH'S SURGERY CENTER LP | 201019390 - (CA) ST JOSEPHS SURGERY CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54380 | $1746.00 | 1003889379 - THE WALDORF ENDOSCOPY ASC, LLC, WALDORF ENDOSCOPY CENTER | 621806186 - (MD) THE WALDORF ENDOSCOPY ASC LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54380 | $1224.00 | 1295700086 - WESTERN WASHINGTON ENDOSCOPY CENTERS, LLC | 200289310 - (WA) WESTERN WASHINGTON ENDOSCOPY CENTERS LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54380 | $2009.00 | 1134665193 - NHPE, LLC, NEW HYDE PARK ENDOSCOPY | 471158058 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54380 | $6154.00 | 1932146990 - CHCA MAINLAND, L.P., MAINLAND MEDICAL CENTER | 621801360 | TX | 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 | $2450.00 | 1306375837 - CENTRAL COAST CARDIOVASCULAR ASC LLC | 821736669 - (CA) CENTRAL COAST CARDIOVASCULAR ASC LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54380 | $9098.00 | 1215060546 - TEXAS HEALTH HARRIS METHODIST HOSPITAL STEPHENVILLE | 751752253 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL STEPHENVILLE | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54380 | $1409.00 | 1235132481 - CYPRESS AMBULATORY SURGERY CENTER | 770568944 - (CA) CYPRESS AMBULATORY SURGERY CEN | 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 | $4397.00 | 1508978990 - WOODBRIDGE CENTER LLC, ENDOSCOPY AND SURGERY CENTER AT WOODBRIDGE HILLS | 30553583 - (MI) WOODBRIDGE CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54380 | $3210.00 | 1750491205 - ENT SURGERY CENTER OF ATLANTA,LLC | 200075229 - (GA) ENT SURGERY CENTER OF ATLANTALLC | GA | 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 | Correct Abnormal Penis Curve, Surgery To Correct An Abnormal Curve In The Penis. The Procedure Involves Removal Of Tissue From One Side Of The Penis To Correct The Shape. |
| 54380-CPT | High | Reconstruct Penis And Urethra, Surgery To Correct A Urethra That Has Formed With An Extra Opening. The Condition May Cause Incontinence. Surgery Closes The Additional Opening And Ensures Urine Flows Properly Out The Penis. |
| 54385-CPT | High | Reconstruct Penis And Urethra, Surgery To Correct A Urethra That Has Formed With An Extra Opening. The Condition May Cause Incontinence. Surgery Closes The Additional Opening And Ensures Urine Flows Properly Out The Penis. |
| 54405-CPT | High | Penis Implant Surgery, Surgery To Implant A Prosthesis Into The Penis. A Prosthesis May Be Semi-Rigid Or Inflatable. The Inflatable Prosthesis May Include A Pump And Reservoir As Well. |
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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