CPT 54400 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • GC - Service performed by resident under supervision • 22 - Increased Procedural Services |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 54400 |
National average reimbursement for CPT 54400 by major payers:
$678.30
$714.71
$747.64
$915.98
| 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 54400 | ||||||
United | 54400 | $5965.00 | 1699144915 - WEST ORANGE ASC LLC, GREGORI SURGERY CENTER | 474739080 - (NJ) WEST ORANGE ASC LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54400 | $3265.00 | 1114177417 - NISENFELD & CHILTON, MD PA, ORTHOPAEDIC ASSOCIATES OF FREDERICK, ASC | 521135399 - (MD) NISENFELD & CHILTON, M.D., P.A. | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54400 | $11960.00 | 1235752643 - TEXAS HEALTH SURGERY CENTER SOUTHWEST FORT WORTH, LLC | 843814490 - (TX) TEXAS HEALTH SURGERY CENTER SOUTHWEST FORT WORTH LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54400 | $4350.00 | 1881193183 - SOUTHSIDE SPECIALTY SURGICAL CENTER LLC | 823920550 - (TX) SOUTHSIDE SPECIALTY SURGICAL CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54400 | $10467.00 | 1609920206 - UPMC JAMESON, UPMC JAMESON SHORT PROCEDURE UNIT | 250965406 - (PA) UPMC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54400 | $9793.00 | 1306989249 - MEDICAL ARTS SURGERY CENTER LLC | 208261564 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54400 | $11101.00 | 1770837866 - SPINE AND PAIN PHYSICIANS SURGERY CENTER, LLC | 454831116 - (TN) SPINE AND PAIN PHYSICIANS SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54400 | $4808.00 | 1306320338 - ALABAMA EYE SURGERY CENTER LLC | 814662532 - (AL) ALABAMA EYE SURGERY CENTER LLC | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54400 | $12291.00 | 1659301794 - MEMORIAL HERMANN SURGERY CENTER TEXAS MEDICAL CENTER, LLP, MEMORIAL HERMANN SURGERY CENTER TEXAS MEDICAL CENTER | 203233666 - (TX) MEMORIAL HERMANN SURGERY CENTER TEXAS MEDICAL CENTER LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54400 | $2458.00 | 1346878303 - HOT SPRINGS AMBULATORY SURGERY CENTER, LLC | 832533389 - (AR) HOT SPRINGS AMBULATORY SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54400 | $13200.00 | 1356773584 - SURGERY CENTER OF MUNSTER, LLC, THE CENTER FOR MINIMALLY INVASIVE SURGERY | 461961043 - (IN) SURGERY CENTER OF MUNSTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54400 | $953.05 | 1588875231 - DEEPA GHANTA | 350593390 - DEACONESS HOSPITAL INC | IN | Hospitalist Physician (208M00000X) |
United | 54400 | $6750.00 | 1750343083 - LEXINGTON SURGERY CENTER LTD | 611028180 - (KY) LEXINGTON SURGERY CENTER LTD | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54400 | $6189.00 | 1306093604 - BOX CANYON SURGERY CENTER LLC | 263086826 - (NV) BOX CANYON SURGERY CENTER LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54400 | $7102.00 | 1346988870 - E-ASC LLC, BEACON EVENDALE SURGICAL CENTER | 882263306 | OH | 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 54400 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54400 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 54400 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 |
|---|---|---|
| 54400-CPT | Moderate | Insertion Prosthesis Penis |
| 54401-CPT | Moderate | Insert Prosthes Penis-Inflatable |
| 54405-CPT | High | Insertion Of Multi-Component, Inflatable Penile Prosthesis, Including Placement Of Pump, Cylinders, & Reservoir - Commercial Rn Review>=11/17/2021 |
| 54406-CPT | Moderate | Removal Of All Components Of Multi-Component, Inflatable Penile Prosthesis Without Replacement Of Prosthesis - 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 54400. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54400 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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