CPT 54405 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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • AS - PA/NP/CNS assistant at surgery • 80 - Assistant surgeon |
| Complexity Level | High |
| CMS | $786.02 Physician Fee Schedule |
National average reimbursement for CPT 54405 by major payers:
$1,022.32
$1,084.80
$1,194.37
$1,377.05
| 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 54405 | ||||||
United | 54405 | $1054.33 | 1528582699 - SOUND PHYSICIANS INTENSIVISTS OF WASHINGTON PLLC | 821915266 | WA | Multi-Specialty Group (193200000X) |
United | 54405 | $1111.01 | 1396787925 - MARY LASLEY | 910946924 - (WA) NORTHWEST ASTHMA & ALLERGY CENTER | WA | Allergy & Immunology Physician (207K00000X) |
United | 54405 | $2063.56 | 1790103976 - BRADLEY PETTY | 910655392 - KADLEC REGIONAL MEDICAL CENTER | WA | Otolaryngology Physician (207Y00000X) |
United | 54405 | $1145.11 | 1063696946 - SPOKANE AUDIOLOGY CLINIC, INC. | 872868888 - (WA) SC AUDIOLOGY PLLC | WA | Multi-Specialty Group (193200000X) |
United | 54405 | $1115.03 | 1912297219 - SYLVIA CASTRO | 833929247 - DAIYA HEALTHCARE | WA | Multi-Specialty Group (193200000X) |
United | 54405 | $1402.18 | 1710973839 - SANJEEV JAIN | 870695702 - (OR) ASTHMA ALLERGY CENTRE | WA | Allergy & Immunology Physician (207K00000X) |
United | 54405 | $852.22 | 1982939955 - LINDSAY HAMPSON | 943281666 | WA | Urology Physician (208800000X) |
United | 54405 | $1755.07 | 1336646066 - DANIEL LEE | 911606533 - (WA) PROLIANCE SURGEONS, INC., P.S. | WA | Otolaryngology Physician (207Y00000X) |
United | 54405 | $11154.00 | 1902228455 - PROVIDENCE HEALTH & SERVICES WASHINGTON, PROVIDENCE SURGERY AND PROCEDURE CENTER | 911491167 | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54405 | $1068.56 | 1467688069 - LISA WINTERROTH | 910946924 - (WA) NORTHWEST ASTHMA & ALLERGY CENTER | WA | Allergy & Immunology Physician (207K00000X) |
United | 54405 | $1075.02 | 1891101333 - PINNACLE INTEGRATIVE HEALTH PC | 471255472 - (WA) PINNACLE INTEGRATIVE HEALTH PC | WA | Multi-Specialty Group (193200000X) |
United | 54405 | $1555.26 | 1760568273 - WALLA WALLA CLINIC, INC., WALLA WALLA CLINIC AMBULATORY SURGERY CENTER | 910862542 - WALLA WALLA CLINIC, INC. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54405 | $7562.00 | 1184689408 - EVERGREEN EYE CENTER, PLLC, EYE ASSOCIATES NORTHWEST SURGERY CENTER | 911610832 - (WA) EYE ASSOCIATES NORTHWEST, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54405 | $981.53 | 1902983174 - SELAH MEDICAL CENTER INC. | 205552744 - (WA) SELAH MEDICAL CENTER INC | WA | Multi-Specialty Clinic/Center (261QM1300X) |
United | 54405 | $2320.39 | 1760626386 - NICHOLAS COWAN | 910565539 - (WA) VIRGINIA MASON MEDICAL CENTER | WA | Urology Physician (208800000X) |
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 54405 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54405 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 54405 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 54405. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54405 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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