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See a sample rate comparisonCPT 54385 Fee Schedule
Last Verified: October 2026
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.
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.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Male Genital System |
| Common Place of Service | 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 62 - Co-Surgeons PT - Colorectal cancer screening test; converted to diagnostic test or other procedure |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 54385 |
| Medicaid Fee Schedule | View Medicaid rates for 54385 |
National average reimbursement for CPT 54385 by major payers:
$1,124.08
$1,273.42
$1,301.78
$1,545.17
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CPT 54385
5 of 25 sample ratesHigher to lower in this preview
Alaska Surgery Center, Limited Partnership
Alaska Surgery Center Limited Partnership
$8,156.00Published rateSurgery Center Of Peoria, LLC, Surgery Center Of Peoria
Surgery Center Of Peoria LLC
$3,500.00Published ratePhysicians Pavilion Lp, Physicians Pavilion Surgery Center
$2,434.00Published rateEye Surgery Centers Of New Mexico, LLC, Surgery Center Of Santa Fe
Eye Surgery Centers Of New Mexico LLC
$1,778.00Published rateMid-Bronx Endoscopy Center LLC
Midbronx Endoscopy Center LLC
$400.00Published rate
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See a sample payer proposalCPT 54385 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54385 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 54385 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 |
|---|---|---|
| 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. |
| 54390-CPT | High | Reconstruct Penis And Urethra, Surgery To Construct A Single Urethra Opening In The Penis As Well As Reconstruct A Bladder That Has Formed Inside-Out (Exstrophy). The Surgery Involves Major Reconstruction Of The Bladder And Passages From The Kidneys (Ureters). |
| 54410-CPT | High | Remove Replace Penis Prosth, Removal And Replacement Of All Component S Of A Multi Component Inflatable Penile Prosthesis At The Same Operative Session |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 54385. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54385 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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