CPT 54390 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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 22 - Increased Procedural Services • 82 - Assistant surgeon - no qualified resident |
| Complexity Level | High |
| CMS | $1,202.32 Physician Fee Schedule |
National average reimbursement for CPT 54390 by major payers:
$1,547.79
$1,657.19
$1,728.87
$2,074.94
| 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 54390 | ||||||
United | 54390 | $1591.00 | 1073682159 - CENTRAL MASSACHUSETTS AMBULATORY ENDOSCOPY CENTER LLC | 830375714 | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54390 | $1442.00 | 1568674281 - VILLAGES ENDOSCOPY & SURGICAL CENTER LLC | 813250494 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54390 | $1839.00 | 1235178146 - SUBURBAN ENDOSCOPY CENTER, LLC, SUBURBAN ENDOSCOPY CENTER | 820556996 - (NJ) SUBURBAN ENDOSCOPY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54390 | $3338.00 | 1609871847 - THE SURGERY CENTER, LLC | 582520623 - (GA) THE SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54390 | $1567.00 | 1821067554 - OLD TOWN ENDOSCOPY CENTER LLC, DIGESTIVE HEALTH CENTER OF DALLAS | 752774028 - (TX) OLD TOWN ENDOSCOPY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54390 | $3600.00 | 1063058303 - CHESAPEAKE REGIONAL SURGERY CENTER AT VIRGINIA BEACH, LLC | 843621271 - (VA) CHESAPEAKE REGIONAL SURGERY CENTER AT VIRGINIA BEACH LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54390 | $6886.00 | 1023071560 - MEDICAL PLAZA AMBULATORY SURGERY CENTER ASSOCIATES, L.P., MEDICAL CITY SURGERY CENTER/FORT WORTH | 621489404 - (TX) MEDICAL PLAZA AMBULATORY SURGERY CENTER ASSOCIATES LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54390 | $1026.31 | 1790275766 - SPENCER GREENWOOD | 350593390 - DEACONESS HOSPITAL INC | IN | Certified Registered Nurse Anesthetist (367500000X) |
United | 54390 | $885.00 | 1073588356 - DIGESTIVE HEALTH SPECIALISTS ENDOSCOPY CENTER ARIZONA, LLC | 201456252 - (AZ) DIGESTIVE HEALTH SPECIALISTS ENDOSCOPY CENTER ARIZONA LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54390 | $4785.00 | 1194727883 - PROLIANCE SURGEONS, INC., P.S., PROLIANCE PUGET SOUND SURGERY CENTER | 911606533 - (WA) PROLIANCE SURGEONS, INC., P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54390 | $3090.00 | 1053562959 - PROHEALTH ALIGNED LLC, PROHEALTH CARE MORELAND SURGERY CENTER | 263324572 - (WI) PROHEALTH ALIGNED LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54390 | $3750.00 | 1548827637 - HEDWIG ASC, HOUSTON PREMIERSURGERY CENTER THE VILLAGES | 831849530 - (TX) HEDWIG ASC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54390 | $3393.00 | 1265009005 - SURGCENTER NORTHERN PHOENIX LLC | 854160690 - (AZ) SURGCENTER NORTHERN PHOENIX LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54390 | $2300.00 | 1922531268 - AMERICAN ACCESS CARE OF BALTIMORE ASC LLC | 814584087 - (MD) AMERICAN ACCESS CARE OF BALTIMORE ASC LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54390 | $2222.00 | 1689175333 - NEPHROLOGY & ENDOCRINE ASSOCIATES INC | 880136773 - (NV) NEPHROLOGY & ENDOCRINE ASSOCIATES INC | NV | 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 54390 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54390 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 54390 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 |
|---|---|---|
| 54385-CPT | High | Plast.Op-Penis-Epispad.Dist-Ext.Sphinc; |
| 54390-CPT | High | Rep Penis Epispadias W Exstrophy |
| 54400-CPT | Moderate | Insertion Prosthesis Penis |
| 54411-CPT | High | Removal And Replacement Of All Components Of A Multi-Component Inflatable Penile Prosthesis Through An Infected Field At The Same Operative Session, Including Irrigation And Debridement Of Infected Tissue |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 54390. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54390 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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