CPT 54415 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 • 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 54415 |
National average reimbursement for CPT 54415 by major payers:
$654.72
$703.24
$745.58
$889.86
| 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 54415 | ||||||
United | 54415 | $1782.00 | 1679585772 - MEDICAL CENTER ENDOSCOPY, LLC, MEDICAL CENTER ENDOSCOPY | 760550704 - (TX) MEDICAL CENTER ENDOSCOPY, LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54415 | $1750.00 | 1669405684 - PACIFICOAST AMBULATORY SURGICENTER, LLC., PACIFIC COAST AMBULATORY SURGICENTER | 474003673 - (CA) PACIFICOAST AMBULATORY SURGICENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54415 | $679.00 | 1881616357 - CINCINNATI HEALTH CARE GROUP PSC | 621719097 | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54415 | $3058.00 | 1639261365 - SPECIALISTS ONE- DAY SURGERY LLC, SPECIALISTS ONE-DAY SURGERY | 161601940 - (NY) SPECIALISTS ONE DAY SURGERY LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54415 | $550.00 | 1750313144 - AMBULATORY SURGICAL CARE, LLC | 593082994 - (FL) AMBULATORY SURGICAL CARE LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54415 | $4192.00 | 1245820042 - ALOE SURGICAL CENTER SCOTTSDALE, LLC | 845112576 - (AZ) ALOE SURGICAL CENTER SCOTTSDALE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54415 | $3188.00 | 1548784556 - NORTH ATLANTIC SURGICAL SUITES, LLC | 821540859 - (NH) NORTH ATLANTIC SURGICAL SUITES, LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54415 | $1538.00 | 1255860383 - EYE SURGERY CENTER OF KNOXVILLE, LLC | 611793948 - (TN) EYE SURGERY CENTER OF KNOXVILLE LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54415 | $2445.00 | 1851367486 - GRHS, LLC, ROCHESTER AMBULATORY SURGERY CENTER | 453685937 - (NY) ROCHESTER AMBULATORY SURGERY CENTER | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54415 | $1500.00 | 1376716316 - CPM SURGERY CENTER LLC | 261382311 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54415 | $863.00 | 1538109384 - PLASTIC SURGERY SPECIALISTS, PC | 521357688 - (MD) PLASTIC SURGERY SPECIALISTS, P.C. | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54415 | $3347.00 | 1043803877 - PALM BEACH INTERNATIONAL SURGERY CENTER LLC, PALM BEACH INTERNATIONAL SURGERY CENTER AT THE PALEY INSTITUTE | 384092545 - (FL) PALM BEACH INTERNATIONAL SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54415 | $3663.00 | 1043283906 - NAUGATUCK VALLEY ENDOSCOPY CENTER, LLC, WATERBURY SURGERY CENTER | 260078381 - (CT) NAUGATUCK VALLEY ENDOSCOPY CENTE | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54415 | $2266.00 | 1336209451 - SADDLE RIVER VALLEY SURGICAL CENTER LLC, SADDLE RIVER VALLEY SURGICAL CENTER LLC | 201250583 - (NJ) SADDLE RIVER VALLEY SURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54415 | $844.00 | 1639618036 - PRESENCE LAKESHORE GASTROENTEROLOGY, LLC | 811750563 - (IL) PRESENCE LAKESHORE GASTROENTEROLOGY LLC DBA DES PLAINES ENDOSCOPY CENT | IL | 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 54415 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54415 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 54415 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 |
| 54415-CPT | Moderate | Removal Of Non-Inflatable (Semi-Rigid) Or Inflatable (Self-Contained) Penile Prosthesis, Without Replacement Of Prosthesis |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 54415. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54415 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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