CPT 54435 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 • 78 - Return to OR - related procedure • AG - Primary physician |
| Complexity Level | Moderate |
| CMS | $406.27 Physician Fee Schedule |
National average reimbursement for CPT 54435 by major payers:
$535.50
$554.00
$567.35
$698.36
| 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 54435 | ||||||
United | 54435 | $2273.00 | 1811940141 - SOUTHPARK SURGERY CENTER LLC, SOUTHPARK SURGERY CENTER | 870714098 - (NC) SOUTHPARK SURGERY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54435 | $1226.00 | 1023567260 - SKI AMBULATORY SURGICAL CENTERS, LLC | 813831008 - (AZ) SKI AMBULATORY SURGICAL CENTERS LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54435 | $1310.00 | 1598952061 - ENDOSCOPY ASSOCIATES, LLC | 142006705 - (VA) ENDOSCOPY ASSOCIATES LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54435 | $1134.00 | 1558748996 - NEMG GASTROENTEROLOGY LLC, FAIRFIELD COUNTY ENDOSCOPY CENTER | 473578382 | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54435 | $2100.00 | 1447685458 - CHECKERSPOT SURGERY CENTERS, LLC | 463181931 - (MD) CHECKERSPOT SURGERY CENTERS LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54435 | $1255.00 | 1306005343 - DIGESTIVE HEALTH SPECIALISTS, PA | 561242980 - (NC) DIGESTIVE HEALTH SPECIALISTS, P.A. | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54435 | $1273.00 | 1023115078 - MAIN LINE PA ENDOSCOPY ASC LP, MAIN LINE ENDOSCOPY CENTER MALVERN | 205301211 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54435 | $4213.00 | 1447995311 - NEW ENGLAND BAPTIST SURGERY CENTER LLC | 874311329 - (MA) NEW ENGLAND BAPTIST SURGERY CENTER LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54435 | $2081.00 | 1679108914 - PRECISION SC, LLC, PRECISIONCARE SURGERY CENTER | 832882696 - (NY) PRECISION SC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54435 | $2924.00 | 1780673327 - LAKEWOOD SURGERY CENTER, LLC | 371470145 - (NJ) LAKEWOOD SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54435 | $1002.00 | 1841589116 - RENAISSANCE SURGERY CENTER OF CHATTANOOGA, LLC | 273013392 - (TN) RENAISSANCE SURGERY CENTER OF CHATTANOOGA LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54435 | $3623.00 | 1912933680 - SOUTHWESTERN AMBULATORY SURGERY CENTER, LLC | 562422009 - (PA) SOUTHWESTERN AMBULATORY SURGERY CENTER | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54435 | $3500.00 | 1649707324 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54435 | $6957.00 | 1649931072 - MEDICAL CITY SPECIALTY SURGICENTER OF DALLAS, LLC, MEDICAL CITY ORTHOPEDIC & SPINE SURGERY CENTER DALLAS | 842824507 - (TX) MEDICAL CITY SPECIALTY SURGICENTER OF DALLAS LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54435 | $920.00 | 1073581880 - AMBULATORY SURGERY CENTER LLC, THE CENTER FOR SAME DAY SURGERY | 481114690 - (KS) AMBULATORY SURGERY CENTER, LLC | KS | 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 54435 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54435 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 54435 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 54435. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54435 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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