CPT 54406 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 21 - Inpatient Hospital |
| Common Modifiers | None 78 - Return to OR - related procedure 52 - Reduced Services |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 54406 |
National average reimbursement for CPT 54406 by major payers:
$942.19
$973.78
$1,032.25
$1,193.09
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 54406 | $6290.00 | 1417922915 - FRANCONIA-SPRINGFIELD SURGERY CENTER, LLC, INOVA SURGERY CENTER @ FRANCONIA-SPRINGFIELD | 542018390 - (VA) INOVA AMBULATORY SURGICAL CENTERS | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54406 | $1436.00 | 1033734793 - NAPLES SUNCOAST SURGERY CENTER, LLC | 842343047 - (FL) NAPLES SUNCOAST SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54406 | $1165.00 | 1710952130 - MARYLAND ENDOSCOPY CENTER LLC, MARYLAND ENDOSCOPY CENTER | 521888989 - (MD) MARYLAND ENDOSCOPY CENTER, LLC. | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54406 | $2100.00 | 1043760184 - AUBURN SURGERY CENTER INC | 431937843 - (MO) AUBURN SURGERY CENTER INC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54406 | $2717.00 | 1891701611 - ESSEX ENDOSCOPY CENTER LLC | 223777761 - (NJ) ESSEX ENDOSCOPY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54406 | $1209.00 | 1093736795 - HATTIESBURG CLINIC PA, AMBULATORY SURGERY CENTER | 640507572 - HATTIESBURG CLINIC, P.A. | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54406 | $603.51 | 1962641431 - LARESSA BAZZELL | 350593390 - DEACONESS HOSPITAL INC | KY | Certified Registered Nurse Anesthetist (367500000X) |
United | 54406 | $3570.00 | 1215091087 - CORPUS CHRISTI SURGICARE LTD, CHRISTUS SPOHN TEXAS ORTHOPEDIC CENTER OF EXCELLENCE | 753049514 - (TX) CORPUS CHRISTI SURGICARE LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54406 | $3623.00 | 1962788059 - SURGCENTER OF SILVER SPRING, LLC | 452950933 - (MD) SURGCENTER OF SILVER SPRING LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54406 | $3500.00 | 1275292229 - SCOTTSDALE ENDOSCOPY ASC LLC | 873952617 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54406 | $3623.00 | 1841231792 - NORTH HAVEN SURGERY CENTER LLC, NORTH HAVEN PAIN MEDICINE CENTER, LLC | 770656233 - (CT) NORTH HAVEN SURGERY CENTER LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54406 | $1056.00 | 1073888103 - SURGERY BY VOLD VISION | 454504788 - (AR) SURGERY BY VOLD VISION | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54406 | $2832.00 | 1679235584 - ALLINA HEALTH HEART AND VASCULAR SURGERY CENTER LLC | 872158427 - (MN) ALLINA HEALTH HEART AND VASCULAR SURGERY CENTER LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54406 | $1313.52 | 1346669496 - CARLOS OSORIO | 350593390 - DEACONESS HOSPITAL INC | OH | Pulmonary Disease Physician (207RP1001X) |
United | 54406 | $2771.00 | 1902204654 - DENVER SURGICENTER, LLC | 472340660 | 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 54406 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54406 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 54406 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 |
|---|---|---|
| 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. |
| 54406-CPT | Moderate | Remove Muti Comp Penis Pros, Removal Of All Components Of A Multi Component Inflatable Penile Prosthesis Without Replacement Of Prosthesis |
| 54408-CPT | Moderate | Rpair Of Compone(S) Of A Multi-Compone Inflate Penile Prosthe, Repair Of Component(S) Of A Multi-Component Inflatable Penile Prosthe |
| 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 54406. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54406 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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