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 |
| CMS | $623.64 Physician Fee Schedule |
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 | $1028.00 | 1184125809 - SUMMIT AMBULATORY SURGICAL CENTER LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54430 | $1055.69 | 1417944778 - MERRIMACK VALLEY ENDOSCOPY CENTER | 43578297 - (MA) MERRIMACK VALLEY ENDOSCOPY CENTER | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54430 | $1367.00 | 1356965750 - PROLIANCE SURGERY CENTER AT VALLEY, LLC | 842108616 - (WA) PROLIANCE SURGERY CENTER AT VALLEY LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54430 | $510.00 | 1063853174 - NATIONAL SURGICAL CENTERS OF AMERICA LLC, NSCOA THE VILLAGES | 264278807 - (FL) NATIONAL SURGICAL CENTERS OF AMERICA LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54430 | $840.00 | 1417286428 - ALLIANCE SURGICAL CENTER LLC | 271367127 - (FL) ALLIANCE SURGICAL CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54430 | $744.00 | 1407851090 - WICHITA FALLS ENDOSCOPY CENTER | 200474975 - (TX) WICHITA FALLS ENDOSCOPY CENTER | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54430 | $360.00 | 1609103399 - TOURNEY PLAZA SURGICAL CENTER | 262034187 - (CA) TOURNEY PLAZA SURGICAL CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54430 | $850.00 | 1407812498 - LOYOLA AMBULATORY SURGERY CENTER AT OAKBROOK LP | 364119522 - (IL) LOYOLA AMBULATORY SURGERY CENTER AT OAKBROOK LP | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54430 | $850.00 | 1821036534 - PARKWAY SURGERY CENTER, LLC | 204127100 - (MD) PARKWAY SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54430 | $797.00 | 1689003766 - CANYON VIEW ASC, LLC, CANYON VIEW ASC | 455352976 - (CO) CANYON VIEW ASC LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54430 | $1167.00 | 1366515504 - RIVERSIDE AMBULATORY SURGERY CENTER, LLC, THE ENDOSCOPY & COLONOSCOPY CENTER | 205227186 - (MO) RIVERSIDE AMBULATORY SURGERY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54430 | $1350.00 | 1235551052 - LONG ISLAND DIGESTIVE ENDOSCOPY CENTER, LLC | 454714972 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54430 | $734.00 | 1366868572 - PREMIER SURGERY CENTER, LLC | 463321793 - (NC) PREMIER SURGERY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54430 | $363.00 | 1396700753 - HALCYON LASER & SURGERY CENTER, INC. | 770410936 - (CA) HALCYON LASER SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54430 | $193.00 | 1457502239 - APOLLO SURGERY CENTER LLC | 261387775 - (FL) APOLLO SURGERY CENTER LLC | FL | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 54430) and we'll show you how you compare in 15 minutes or less.