CPT 54385 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 |
| 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 |
National average reimbursement for CPT 54385 by major payers:
$1,124.08
$1,273.42
$1,301.78
$1,582.29
| 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 54385 | ||||||
United | 54385 | $3623.00 | 1295479780 - ADVENTHEALTH SURGERY CENTER DAVENPORT LLC | 881811228 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54385 | $3800.00 | 1023370251 - O'CONNOR BUILDING SURGERY CENTER LLC | 455437708 - (CA) OCONNOR BUILDING SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54385 | $1763.00 | 1942458062 - ASC DEVELOPMENT COMPANY, LLC | 203405773 - (MD) ASC DEVELOPMENT COMPANY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54385 | $1900.00 | 1326054172 - FORT SANDERS WEST OP SURGERY CENTER | 621366907 - (TN) FORT SANDERS WEST OP SURGERY CENTER | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54385 | $3347.00 | 1548784556 - NORTH ATLANTIC SURGICAL SUITES, LLC | 821540859 - (NH) NORTH ATLANTIC SURGICAL SUITES, LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54385 | $4880.00 | 1770566192 - SUMMERLIN BEND SURGERY CENTER LLP, ADULT & CHILDRENS SURGERY CENTER OF SOUTHWEST FLORIDA | 651005912 - (FL) SUMMERLIN BEND SURGERY CENTER | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54385 | $3201.00 | 1487246229 - PRESBYTERIAN RUST MEDICAL CENTER ASC LLC, NEW MEXICO SURGERY CENTER-MULTI SPECIALTY | 861495452 | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54385 | $3580.00 | 1124083878 - THREE GABLES SURGERY CENTER LLC | 870648900 - (OH) THREE GABLES SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54385 | $1350.00 | 1336104926 - ATLANTA SURGERY CENTER LTD | 742452953 - (GA) ATLANTA SURGERY CENTER LTD | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54385 | $826.00 | 1427020213 - TOLEDO ENDOSCOPY ASC LLC, NORTHWEST OHIO ENDOSCOPY CENTER | 621734002 - (OH) TOLEDO ENDOSCOPY ASC LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54385 | $1800.00 | 1780764829 - NOVAMED SURGERY CENTER OF ST PETERS LLC, ST PETERS AMBULATORY SURGERY CENTER | 205579933 - (MO) NOVAMED SURGERY CENTER OF ST PETERS LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54385 | $1226.00 | 1275077414 - SKI AMBULATORY SURGICAL CENTERS, LLC | 813831008 - (AZ) SKI AMBULATORY SURGICAL CENTERS LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54385 | $2860.00 | 1386161495 - MEDSTAR SURGERY CENTER AT BRANDYWINE, LLC | 820985178 - (MD) MEDSTAR SURGERY CENTER AT BRAN | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54385 | $2233.00 | 1003575218 - RENAL FOCUS ASC LLC, RENAL FOCUS ASC PLAINVIEW | 863151108 - (NY) RENAL FOCUS ASC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54385 | $1778.00 | 1255373676 - EYE SURGERY CENTERS OF NEW MEXICO, LLC, SURGERY CENTER OF SANTA FE | 850478109 - (NM) EYE SURGERY CENTERS OF NEW MEXICO LLC | NM | 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 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 | Repair Penis Espispadias |
| 54385-CPT | High | Plast.Op-Penis-Epispad.Dist-Ext.Sphinc; |
| 54390-CPT | High | Rep Penis Epispadias W Exstrophy |
| 54410-CPT | High | Removal & Replacement Of All Component Of Multi-Component, Inflatable Penile Prosthesis At Same Operative Session - Rn Review<6/20/2013 |
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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