CPT 54401 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 • UB • 74 - Discontinued After Anesthesia • 80 - Assistant surgeon • GR - Hospital ESRD facility to Residence |
| Complexity Level | Moderate |
| CMS | $652.11 Physician Fee Schedule |
National average reimbursement for CPT 54401 by major payers:
$781.13
$879.48
$910.97
$1,134.55
| 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 54401 | ||||||
United | 54401 | $4594.00 | 1760414056 - VAN DYCK ASC, LLC | 621817203 - (TN) VAN DYCK ASC LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54401 | $2279.00 | 1497312540 - MEMORIAL HERMANN SURGERY CENTER MAIN STREET, LLC | 384114079 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54401 | $989.00 | 1760860977 - MID MISSOURI SURGERY CENTER, LLC, SURGERY CENTER AT THE FORUM | 464006663 - (MO) MID-MISSOURI SURGERY CENTER, LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54401 | $14302.00 | 1891253035 - ADVANCED CENTER FOR SURGERY, THE ADVANCED CENTER FOR SURGERY | 611917634 - (FL) ADVANCED CENTER FOR SURGERY | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54401 | $6400.00 | 1548827637 - HEDWIG ASC, HOUSTON PREMIERSURGERY CENTER THE VILLAGES | 831849530 - (TX) HEDWIG ASC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54401 | $22698.00 | 1245575919 - MEMORIALCARE SURGICAL CENTER AT SADDLEBACK LLC, MEMORIALCARE SURGICAL CENTER LAGUNA WOODS | 203678259 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54401 | $11261.00 | 1013471754 - ADVANCED SURGERY CENTER OF LANCASTER, LLC | 831133719 - (PA) ADVANCED SURGERY CENTER OF LANCASTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54401 | $9255.00 | 1962011775 - CLEARWAY SURGERY CENTER OF PRINCE FREDERICK LLC | 844787769 - (MD) CLEARWAY SURGERY CENTER OF PRINCE FREDERICK LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54401 | $8582.00 | 1821379538 - THE AESTHETIC SURGERY CENTRE, PLLC, CEDAR LASER AND SURGERY CENTER | 900210545 - (WA) AESTHETIC SURGERY CENTRE, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54401 | $6207.00 | 1275642480 - EGNM LLC, LEWES SURGERY CENTER | 510411737 - (DE) EGNM, LLC DBA LEWES SURGERY CENTER | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54401 | $1110.00 | 1023015989 - TUCSON GASTROENTEROLOGY INSTITUTE, LLC | 860966257 - (AZ) TUCSON GASTROENTEROLOGY INSTITUTE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54401 | $11030.00 | 1548784556 - NORTH ATLANTIC SURGICAL SUITES, LLC | 821540859 - (NH) NORTH ATLANTIC SURGICAL SUITES, LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54401 | $973.00 | 1700876703 - RIVERSIDE SURGERY CENTER INC | 593599967 - (FL) RIVERSIDE SURGERY CENTER INC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54401 | $10876.00 | 1760773949 - PIEDMONT OUTPATIENT SURGERY CENTER, LLC | 273982668 - (NC) PIEDMONT OUTPATIENT SURGERY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54401 | $12196.00 | 1376230722 - UCHEALTH AMBULATORY SURGERY CENTERS, UCHEALTH EASTVIEW SURGERY CENTER | 383984888 - (CO) UCHEALTH AMBULATORY SURGERY CENTERS | CO | 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 54401 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54401 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 54401 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 |
| 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 54401. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54401 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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