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See a sample rate comparisonCPT 54401 Fee Schedule
Last Verified: October 2026
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.
Penis Implant Surgery, Surgery To Implant A Prosthesis Into The Penis. A Prosthesis May Be Semi-Rigid Or Inflatable. The Inflatable Prosthesis May Include A Pump And Reservoir As Well.
| 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 |
| Medicare Fee Schedule | View Medicare rates for 54401 |
| Medicaid Fee Schedule | View Medicaid rates for 54401 |
National average reimbursement for CPT 54401 by major payers:
$781.13
$879.48
$910.97
$1,089.90
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CPT 54401
5 of 25 sample ratesHigher to lower in this preview
Memorialcare Surgical Center At Saddleback LLC, Memorialcare Surgical Center Laguna Woods
$22,698.00Published rateHealthcare Partners Asc-Lb, LLC, Davita Medical Asc
Healthcare Partners Asclb LLC
$9,970.00Published rateSouthland Endoscopy Center, Southland Endoscopy Center
Southland Endoscopy Center
$6,115.00Published rateFlushing Endoscopy Center, LLC
Flushing Endoscopy Center LLC
$3,896.00Published rateGdc Endoscopy Center LLC
$550.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 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 | Penis Implant Surgery, Surgery To Implant A Prosthesis Into The Penis. A Prosthesis May Be Semi-Rigid Or Inflatable. The Inflatable Prosthesis May Include A Pump And Reservoir As Well. |
| 54401-CPT | Moderate | Penis Implant Surgery, Surgery To Implant A Prosthesis Into The Penis. A Prosthesis May Be Semi-Rigid Or Inflatable. The Inflatable Prosthesis May Include A Pump And Reservoir As Well. |
| 54405-CPT | High | Penis Implant Surgery, Surgery To Implant A Prosthesis Into The Penis. A Prosthesis May Be Semi-Rigid Or Inflatable. The Inflatable Prosthesis May Include A Pump And Reservoir As Well. |
| 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 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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