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See a sample rate comparisonCPT 54430 Fee Schedule
Last Verified: October 2026
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.
Release Of Prolonged Erection, One Of Various Surgeries Designed To Correct Uncontrolled Or Abnormal Blood Flow To The Penis Thus Releasing A Prolonged Erection (Priapism).
| 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 |
| Medicaid Fee Schedule | View Medicaid rates for 54430 |
National average reimbursement for CPT 54430 by major payers:
$791.22
$854.90
$896.79
$1,047.92
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CPT 54430
5 of 25 sample ratesHigher to lower in this preview
Baycare Aurora Kaukauna Surgery Center LLC, Kaukauna Surgery Center
Baycare Aurora Kaukauna Surgery Center LLC
$17,689.00Published rateBay Area Endoscopy Center LLC
$1,274.00Published rateParkway Surgery Center, LLC
Parkway Surgery Center
$850.00Published rateStarkville Surgery Center LLC
$372.00Published rateWinter Haven Sebring Fl Ophthalmology Asc LLC, Eye Surgery & Laser Center
$50.00Published rate
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See a sample payer proposalCPT 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 | Release Of Prolonged Erection, One Of Various Surgeries Designed To Correct Uncontrolled Or Abnormal Blood Flow To The Penis Thus Releasing A Prolonged Erection (Priapism). |
| 54430-CPT | Moderate | Release Of Prolonged Erection, One Of Various Surgeries Designed To Correct Uncontrolled Or Abnormal Blood Flow To The Penis Thus Releasing A Prolonged Erection (Priapism). |
| 54435-CPT | Moderate | Release Of Prolonged Erection, One Of Various Surgeries Designed To Correct Uncontrolled Or Abnormal Blood Flow To The Penis Thus Releasing A Prolonged Erection (Priapism). |
| 54437-CPT | Moderate | Repair Of Traumatic Corporeal, Repair Of Traumatic Corporeal Tear(S) |
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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