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See a sample rate comparisonCPT 54416 Fee Schedule
Last Verified: October 2026
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.
Remv/Repl Penis Contain Pros, Removal And Replacement Of Non-Inflatable (Semi-Rigid) Or Inflatable (Self-Contained) Penile Prosthesis At The Same Operative Session
| 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 22 - Increased Procedural Services 78 - Return to OR - related procedure 80 - Assistant surgeon |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 54416 |
| Medicaid Fee Schedule | View Medicaid rates for 54416 |
National average reimbursement for CPT 54416 by major payers:
$896.94
$943.70
$990.22
$1,165.55
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CPT 54416
5 of 25 sample ratesHigher to lower in this preview
Gateway Ambulatory Surgery Center LLC, Gateway Surgery Center
Gateway Ambulatory Surgery Center
$19,557.00Published rateAmbulatory Center For Endoscopy, LLC
$10,375.00Published rateEye Care Surgery Center Of Memphis, LLC
$6,696.00Published rateRiver View Surgery Center, LLC
$2,300.00Published rateSouth Carolina Endoscopy Center
S.C. Endoscopy Center LLC
$936.00Published rate
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See a sample payer proposalCPT 54416 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54416 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 54416 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 |
|---|---|---|
| 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 |
| 54411-CPT | High | Remov Replc Penis Pros Comp, 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 |
| 54416-CPT | Moderate | Remv/Repl Penis Contain Pros, Removal And Replacement Of Non-Inflatable (Semi-Rigid) Or Inflatable (Self-Contained) 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 54416. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54416 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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