CPT 54416 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 • 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 |
National average reimbursement for CPT 54416 by major payers:
$896.94
$943.70
$990.22
$1,212.70
| 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 54416 | ||||||
United | 54416 | $11533.00 | 1871751859 - WESTMINSTER SURGERY CENTER | 262059600 - (MD) WESTMINSTER SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54416 | $10000.00 | 1720434731 - NEW BRAUNFELS SPINE & PAIN SURGERY | 472062067 - (TX) NEW BRAUNFELS SPINE PAIN SURGERY | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54416 | $3175.00 | 1508342114 - ACTD,LLC, GREEN MOUNTAIN SURGERY CENTER | 472161109 - (VT) ACTDLLC | VT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54416 | $8010.00 | 1396142733 - DIALYSIS ACCESS SERVICES, LLC | 472322456 - (MD) DIALYSIS ACCESS SERVICES LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54416 | $1278.00 | 1902070832 - GASTRO OPERATING COMPANY LLC, (DBA) MEADOWBROOK ENDOSCOPY CENTER | 202432134 - (NY) GASTRO OPERATING COMPANY, LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54416 | $12979.00 | 1710910922 - SURGERY CENTER OF INDEPENDENCE LP | 200670748 - (MO) SURGERY CENTER OF INDEPENDENCE LP | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54416 | $2300.00 | 1831636752 - RIVER VIEW SURGERY CENTER, LLC | 814790945 - (ID) RIVER VIEW SURGERY CENTER, LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54416 | $8747.00 | 1164719209 - SURGICAL SPECIALISTS OF ST LUCIE, BLUE WATER SURGERY CENTER | 260176703 - (FL) SURGICAL SPECIALISTS OF ST. LUCIE COUNTY, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54416 | $3170.00 | 1245781459 - FRESENIUS VASCULAR CARE ST LOUIS ASC LLC, AZURA SURGERY CENTER ST. LOUIS | 814061712 - (MO) FRESENIUS VASCULAR CARE ST LOUIS ASC LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54416 | $19557.00 | 1144312075 - GATEWAY AMBULATORY SURGERY CENTER LLC, GATEWAY SURGERY CENTER | 202106989 - (NC) GATEWAY AMBULATORY SURGERY CENTER | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54416 | $2279.00 | 1518344043 - MEMORIAL HERMANN SURGERY CENTER KIRBY, LLC, MEMORIAL HERMANN SURGERY CENTER KIRBY GLEN | 364801162 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54416 | $10418.00 | 1477507168 - LAKESIDE SURGERY LLC, LAKESIDE SURGERY CENTER | 752714441 - LAKESIDE SURGERY CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54416 | $4953.00 | 1366137440 - SURGERY CENTER OF GEORGETOWN, LLC, GEORGETOWN SURGERY CENTER | 880604963 - (TX) SURGERY CENTER OF GEORGETOWN LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54416 | $936.00 | 1740210459 - SOUTH CAROLINA ENDOSCOPY CENTER | 562069531 - (SC) S.C. ENDOSCOPY CENTER LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54416 | $6088.00 | 1811512734 - SSL ENDOSCOPY CENTER LLC, AVALA SURGERY CENTER | 843735506 - (LA) SSL ENDOSCOPY CENTER LLC | 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 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 | 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 |
| 54416-CPT | Moderate | 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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