CPT 54410 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 • 52 - Reduced Services • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 54410 |
National average reimbursement for CPT 54410 by major payers:
$1,090.93
$1,160.23
$1,235.48
$1,468.35
| 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 54410 | ||||||
United | 54410 | $2235.15 | 1629031752 - WILLIAM ANDERSON | 910369070 - (WA) THE POLYCLINIC, PLLC | WA | Allergy & Immunology Physician (207K00000X) |
United | 54410 | $14093.00 | 1952723967 - HOUSTON METHODIST ST. JOHN HOSPITAL, HOUSTON METHODIST CLEAR LAKE HOSPITAL | 464389870 - (TX) METHODIST HOSPITAL | TX | General Acute Care Hospital (282N00000X) |
United | 54410 | $1185.11 | 1114423928 - HORIZONVIEW HEALTH, PLLC | 824555403 - (WA) HORIZONVIEW HEALTH | WA | Multi-Specialty Group (193200000X) |
United | 54410 | $7295.00 | 1477583334 - NEW MEDICAL HORIZONS II, LTD., CYPRESS FAIRBANKS MEDICAL CENTER HOSPITAL | 742129954 - (TX) NEW MEDICAL HORIZONS II LTD | TX | General Acute Care Hospital (282N00000X) |
United | 54410 | $1341.91 | 1427188465 - NORTHWEST NEUROLOGICAL PLLC | 911982165 - (WA) NORTHWEST NEUROLOGICAL, PLLC | WA | Multi-Specialty Group (193200000X) |
United | 54410 | $8726.00 | 1386858595 - ALDERWOOD SURGERY CENTER LLC | 204979154 - (WA) ALDERWOOD SURGICAL CENTER | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54410 | $7864.00 | 1194047092 - PACIFIC CATARACT AND LASER INSTITUTE INC PC | 911394965 - PACIFIC CATARACT AND LASER INSTITUTE, INC., PC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54410 | $2467.37 | 1235523598 - JJ ZHANG | 910565539 - (WA) VIRGINIA MASON MEDICAL CENTER | OH | Urology Physician (208800000X) |
United | 54410 | $875.36 | 1558306050 - JAMES TODD | 463936183 - (LA) LMG, LLC | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 54410 | $1240.98 | 1093872947 - ERIC WATERMAN | 911992462 - (WA) ERIC T. WATERMAN, MD, PLLC | WA | Otolaryngology Physician (207Y00000X) |
United | 54410 | $18684.00 | 1902857766 - COLUMBIA MEDICAL CENTER OF LAS COLINAS INC, MEDICAL CITY LAS COLINAS | 621650582 - (TX) COLUMBIA MEDICAL CENTER OF LAS COLINAS INC | TX | General Acute Care Hospital (282N00000X) |
United | 54410 | $2014.83 | 1699978247 - NAE-HWA KIM | 911939739 - FRANCISCAN MEDICAL GROUP | WA | Urology Physician (208800000X) |
United | 54410 | $1347.57 | 1437687126 - DHRUV SHARMA | 273645560 - UNIVERSITY OF LOUISVILLE PHYSICIANS INC | WA | Otolaryngology Physician (207Y00000X) |
United | 54410 | $1185.11 | 1720540529 - ONESTOP MEDICAL SERVICES LLC | 822341265 - (WA) ONESTOP MEDICAL SERVICES LLC | WA | Multi-Specialty Group (193200000X) |
United | 54410 | $9050.00 | 1871593269 - ACADIANA SURGERY CENTER, INC. | 721235496 - (LA) ACADIANA SURGERY CENTER INC | LA | 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 54410 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54410 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 54410 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 |
|---|---|---|
| 54406-CPT | Moderate | Removal Of All Components Of Multi-Component, Inflatable Penile Prosthesis Without Replacement Of Prosthesis - Rn Review<6/20/2013 |
| 54408-CPT | Moderate | Repair Of Component(S) Of A Multi-Component, Inflatable Penile Prosthesis |
| 54410-CPT | High | Removal & Replacement Of All Component Of Multi-Component, Inflatable Penile Prosthesis At Same Operative Session - Rn Review<6/20/2013 |
| 54411-CPT | High | Removal And Replacement Of All Components Of A Multi-Component Inflatable Penile Prosthesis Through An Infected Field At The Same Operative Session, Including Irrigation And Debridement Of Infected Tissue |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 54410. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54410 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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