CPT 54411 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 • 21 - Inpatient Hospital |
| Common Modifiers | • None • 78 - Return to OR - related procedure • 52 - Reduced Services |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 54411 |
National average reimbursement for CPT 54411 by major payers:
$1,336.88
$1,362.51
$1,424.96
$1,709.96
| 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 54411 | ||||||
United | 54411 | $1957.00 | 1083776314 - CROZER-CHESTER MEDICAL CENTER | 811507712 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54411 | $330.00 | 1992700090 - TAMPA BAY SPECIALTY SURGERY CENTER LLC, TAMPA BAY SPECIALTY SURGERY CENTER | 331019420 - (FL) TAMPA BAY SPECIALTY SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54411 | $153.00 | 1891750998 - CHARLOTTE SURGERY CENTER, LLC, CHARLOTTE SURGERY CENTER | 561449531 - (NC) CHARLOTTE SURGERY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54411 | $110.00 | 1457379364 - JONESBORO SURGERY CENTER, LLC | 731589472 | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54411 | $541.00 | 1588938682 - WEST SIDE GI, LLC | 271185812 - (NY) WESTSIDE GI CENTER, LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54411 | $2965.00 | 1629032446 - AMBULATORY SURGERY CENTER GROUP LTD | 592073099 - (FL) AMBULATORY SURGERY CENTER GROUP LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54411 | $1846.86 | 1003310616 - CARIDAD PADRON | 350593390 - DEACONESS HOSPITAL INC | AZ | Internal Medicine Physician (207R00000X) |
United | 54411 | $66.00 | 1639215502 - BOSTON EYE SURGERY & LASER CENTER TRUST, BOSTON EYE SURGERY & LASER CENTER | 43092292 - (MA) BOSTON EYE SURGERY & LASER CENTER TRUST | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54411 | $150.00 | 1023542339 - BATON ROUGE VASCULAR ACCESS ASC LLC | 814685509 - (LA) BATON ROUGE VASCULAR ACCESS ASC LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54411 | $361.00 | 1407993132 - DIGESTIVE DISEASE ENDOSCOPY CENTER | 352597463 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54411 | $190.00 | 1568423945 - NW AMBULATORY SURGERY CENTER LLP, NW SURGERY CENTER | 383693604 - (TX) NW AMBULATORY SURGERY CENTER LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54411 | $150.00 | 1023542339 - BATON ROUGE VASCULAR ACCESS ASC LLC | 814685509 - (LA) BATON ROUGE VASCULAR ACCESS ASC LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54411 | $128.00 | 1619940582 - FT MYERS DIGESTIVE HEALTH AND PAIN ASC LLC, CENTER FOR DIGESTIVE HEALTH AND PAIN MANAGEMENT | 621848758 - (FL) FT MYERS DIGESTIVE HEALTH AND PAIN ASC LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54411 | $140.00 | 1811914625 - PUGET SOUND GASTROENTEROLOGY, PLLC, EDMONDS ENDOSCOPY CENTER | 911123468 - (WA) PUGET SOUND GASTROENTEROLOGY, P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54411 | $223.00 | 1194832949 - CHOICES WOMEN'S MEDICAL CENTER, INC. | 112715115 - CHOICES WOMENS MEDICAL CENTER IN | NY | 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 54411 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54411 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 54411 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 54411. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54411 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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