CPT 54420 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 | • 23 - Emergency Room • 21 - Inpatient Hospital |
| Common Modifiers | • None • 58 - Staged or related procedure during postoperative period • AG - Primary physician |
| Complexity Level | Moderate |
| CMS | $684.13 Physician Fee Schedule |
National average reimbursement for CPT 54420 by major payers:
$887.28
$942.56
$970.88
$1,178.75
| 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 54420 | ||||||
United | 54420 | $2430.00 | 1235683798 - ASSOCIATED SURGICAL CENTER LLC | 813492018 - (IL) ASSOCIATED SURGICAL CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54420 | $1357.00 | 1336138635 - EYE SURGICAL SPECIALISTS OF NEW JERSEY, SURGERY CENTER OF CENTRAL NEW JERSEY | 223411416 - (NJ) EYE SURGICAL SPECIALISTS OF NEW JERSEY | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54420 | $2425.00 | 1255896676 - ASCENTIST ASC MERRIAM, LLC, ASCENTIST EAR, NOSE AND THROAT INSTITUTE | 831973214 - (KS) ASCENTIST ASC MERRIAM LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54420 | $2071.00 | 1730401571 - CHILDRENS SURGERY CENTER LLC, ADVENTHEALTH SURGERY CENTER MAITLAND | 262389638 - (FL) CHILDRENS SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54420 | $1650.00 | 1760807127 - PHYSICIANS SURGERY CENTER AT GLENDALE ADVENTIST, LLC | 464085815 - (CA) PHYSICIANS SURGERY CENTER AT GLENDALE ADVENTIST LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54420 | $5310.00 | 1083188478 - ROCKY HILL SURGERY CENTER, LLC | 833096156 - (CT) ROCKY HILL SURGERY CENTER, LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54420 | $3570.00 | 1811515034 - SALMON SURGERY CENTER LLC | 844895716 - (WA) SALMON SURGERY CENTER LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54420 | $790.00 | 1730249327 - AMBULATORY SURGERY CENTER OF WNY | 161554732 - (NY) AMBULATORY SURGERY CENTER OF WNY | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54420 | $2499.00 | 1710615869 - ORTHOILLINOIS SURGERY CENTER ELGIN, LLC | 851212739 - (IL) ORTHOILLINOIS SURGERY CENTER ELGIN LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54420 | $2122.00 | 1457957391 - MIDDLEBROOK ASC, LLC | 843656261 - (TN) MIDDLEBROOK ASC LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54420 | $3570.00 | 1831180272 - ADVANCED ENDOSCOPY CENTER LLC | 861083384 - (MO) ADVANCED ENDOSCOPY CENTER, LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54420 | $3347.00 | 1265534556 - SOUTH FLORIDA AMBULATORY SURGICAL CENTER LLC | 651093026 - (FL) SOUTH FLORIDA AMBULATORY SURGI | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54420 | $5513.00 | 1417534207 - MEDICAL CITY SURGERY CENTER OF FRISCO, LLC | 822432064 - (TX) MEDICAL CITY SURGERY CENTER OF FRISCO LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54420 | $6734.00 | 1093459315 - PERFORMANCE HEALTH SURGICENTER, LLC | 881897351 - (FL) PERFORMANCE HEALTH SURGICENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54420 | $1300.00 | 1487657862 - FILLMORE EYE CLINIC INCORPORATED, FILLMORE EYE CLINIC ASC | 272444464 - (NM) FILLMORE EYE CLINIC, INC. | NM | 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 54420 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54420 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 54420 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 |
|---|---|---|
| 54420-CPT | Moderate | Corpora Cavernosa-Saphenous Vein Shunt,U |
| 54430-CPT | Moderate | Shunt Corpora Cavernosa-Spongiosum |
| 54435-CPT | Moderate | Corpora Cavernosa-Glans Penis Fistulization (Eg, Biopsy Needle, Winter Procedure, Rongeur, Or Punch) For Priapism |
| 54437-CPT | Moderate | Once Per Dos Repair Of Traumatic Corporeal Tear |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 54420. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54420 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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