CPT 54417 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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 78 - Return to OR - related procedure • 22 - Increased Procedural Services |
| Complexity Level | High |
| CMS | $874.33 Physician Fee Schedule |
National average reimbursement for CPT 54417 by major payers:
$1,151.62
$1,192.71
$1,236.22
$1,495.54
| 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 54417 | ||||||
United | 54417 | $450.00 | 1285825075 - SUNNYSIDE SURGERY CENTER, LLC | 201164055 - (ID) SUNNYSIDE SURGERY CENTER LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54417 | $1145.00 | 1003842626 - AMBULATORY CENTER FOR ENDOSCOPY, LLC | 200064962 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54417 | $554.00 | 1316061765 - PUBLIC HOSPITAL DIST NO 1 SKAGIT | 562392010 | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54417 | $1530.00 | 1508978990 - WOODBRIDGE CENTER LLC, ENDOSCOPY AND SURGERY CENTER AT WOODBRIDGE HILLS | 30553583 - (MI) WOODBRIDGE CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54417 | $2307.00 | 1306163431 - ROC SURGERY LLC, RILEY OUTPATIENT SURGERY CENTER | 271497960 - (IN) ROC SURGERY LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54417 | $440.00 | 1235239054 - MAIN LINE PA ENDOSCOPY ASC LP, MAIN LINE ENDOSCOPY CENTER BALA CYNWYD | 205301211 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54417 | $1158.00 | 1811994080 - PACIFIC ENDO-SURGICAL CENTER, LP, PACIFIC ENDO-SURGICAL CENTER | 562387275 - (CA) PACIFIC ENDOSURGICAL CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54417 | $2172.00 | 1275536328 - BELLAIRE OUTPATIENT SURGERY CENTER, LLP, BAYLOR SCOTT & WHITE SURGICARE - OAKMONT | 562297308 - (TX) BELLAIRE OUTPATIENT SURGERY CENTER LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54417 | $200.00 | 1033214903 - SOUTH HILLS DIAGNOSTIC & TREATMENT CENTER LP, SOUTH HILLS ENDOSCOPY CENTER | 861117604 - (PA) SOUTH HILLS DIAGNOSTIC TREATMENT CENTER LP | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54417 | $580.00 | 1437636636 - CCRM DFW, LLC, CCRM DALLAS FORT WORTH | 822959456 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54417 | $343.00 | 1720833163 - MIDWEST EYE CENTER | 363010536 - (IL) MIDWEST EYE CENTER | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54417 | $231.00 | 1043497019 - PIKESVILLE MD ENDOSCOPY ASC LLC, ENDOCENTRE OF BALTIMORE | 261467040 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54417 | $1963.00 | 1881620995 - MCKINNEY SURGERY CENTER, LP, THE SURGERY CENTRE AT CRAIG RANCH | 383897811 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54417 | $335.00 | 1750658092 - ADVANCED CENTER FOR SURGERY, LLC | 273049891 - (PA) ADVANCED CENTER FOR SURGERY, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54417 | $675.00 | 1750874400 - DENVER DIAGNOSTIC ASC, LLC | 825510334 - (CO) DENVER DIAGNOSTIC ASC LLC | CO | 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 54417 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54417 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 54417 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 |
|---|---|---|
| 54400-CPT | Moderate | Insertion Prosthesis Penis |
| 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 |
| 54417-CPT | High | Removal And Replacement Of Non-Inflatable (Semi-Rigid) Or Inflatable (Self-Contained) 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 54417. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54417 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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