CPT 54430 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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • GC - Service performed by resident under supervision • 58 - Staged or related procedure during postoperative period • 78 - Return to OR - related procedure |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 54430 |
National average reimbursement for CPT 54430 by major payers:
$791.22
$854.90
$896.79
$1,072.86
| 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 54430 | ||||||
United | 54430 | $100.00 | 1013096700 - CLEARER VISION, LLC, PERIMETER SURGERY CENTER | 621792483 - (TN) CLEARER VISION, LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54430 | $5658.00 | 1013548833 - ASCENSION WISCONSIN SURGERY CENTER-MOUNT PLEASANT LLC, ASCENSION WISCONSIN SURGERY CENTER-MOUNT PLEASANT | 843972619 - (WI) ASCENSION WISCONSIN SURGERY CENTERMOUNT PLEASANT LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54430 | $786.00 | 1023169380 - JCMG SURGERY CENTER, INC. | 431809950 - (MO) JCMG SURGERY CENTER INC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54430 | $2709.00 | 1902063605 - PENN PRESBYTERIAN MEDICAL CENTER SPU | 232810852 - PRESBYTERIAN MEDICAL CENTER OF THE UNIVERSITY OF PENNSYLVANIA HEALTH | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54430 | $1146.00 | 1386275147 - SURGERY CENTER OF MESA LLC | 813829555 - (AZ) SURGERY CENTER OF MESA LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54430 | $122.00 | 1386794980 - NEW VISION CATARACT CENTER LLC, NEW VISION CATARACT CENTER | 61557487 - (CT) NEW VISION CATARACT CENTER LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54430 | $445.00 | 1912476367 - DIGESTIVE HEALTH SPECIALISTS, PA | 561242980 - (NC) DIGESTIVE HEALTH SPECIALISTS, P.A. | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54430 | $616.00 | 1346240751 - ROSWELL CENTER FOR FOOT & ANKLE SURGERY, LLC | 201549920 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54430 | $773.00 | 1932214624 - LA PEER SURGERY CENTER, LLC, LA PEER HEALTH SYSTEMS | 202788594 - (CA) LAPEER SURGERY CENTER, LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54430 | $1146.00 | 1801825880 - SURGERY CENTER AT RIVER ROAD, LLC, AESTHETIC SURGERY AT HACIENDA DEL SOL | 760824670 - (AZ) SURGERY CENTER AT RIVER ROAD, LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54430 | $832.00 | 1770072803 - PACIFIC VASCUCARE SURGERY CENTER | 823288521 - (CA) PACIFIC VASCUCARE SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54430 | $1028.00 | 1184125809 - SUMMIT AMBULATORY SURGICAL CENTER LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54430 | $2735.00 | 1770252868 - STONESPRINGS SURGICENTER, LLC | 812929320 - (VA) STONESPRINGS SURGICENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54430 | $372.00 | 1942793823 - STARKVILLE SURGERY CENTER LLC | 465332869 - (MS) STARKVILLE SURGERY CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54430 | $100.00 | 1871596114 - NORTHERN ARIZONA SURGICENTER, LLC | 860747413 - (AZ) NORTHERN ARIZONA SURGICENTER LLC | AZ | 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 54430 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54430 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 54430 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 54430. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54430 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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