CPT 54437 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 | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • GC - Service performed by resident under supervision • 52 - Reduced Services |
| Complexity Level | Moderate |
| CMS | $663.43 Physician Fee Schedule |
National average reimbursement for CPT 54437 by major payers:
$925.88
$918.37
$959.51
$1,147.89
| 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 54437 | ||||||
United | 54437 | $638.00 | 1942485305 - 9106 PHILADELPHIA ROAD AMBULATORY SURGERY CENTER LLC | 261539834 - (MD) 9106 PHILADELPHIA ROAD AMBULATORY SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54437 | $902.00 | 1548235963 - THE SCRANTON PA ENDOSCOPY ASC LP, THE SCRANTON ENDOSCOPY CENTER | 202853361 - (PA) THE SCRANTON PA ENDOSCOPY ASC LP | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54437 | $2307.00 | 1538461348 - THE OUTPATIENT CENTER, LLC, THE OUTPATIENT CENTER OF BOYNTON BEACH, LTD. D/B/A THE OUTPATIENT CENT | 650440864 - (FL) THE OUTPATIENT CENTER OF BOYNTON BEACH, LTD. | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54437 | $1400.00 | 1912447418 - LUBBOCK SURGERY CENTER, LLC | 812766547 - (TX) LUBBOCK SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54437 | $1413.00 | 1225665292 - ANNAPOLIS ENDOSCOPY CENTER LLC | 843556524 - (MD) ANNAPOLIS ENDOSCOPY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54437 | $691.00 | 1023266145 - ASC DEVELOPMENT COMPANY, LLC | 203405773 - (MD) ASC DEVELOPMENT COMPANY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54437 | $1506.00 | 1194275230 - WEST SUBURBAN EYE SURGERY CENTER LLC, SURGISITE NORTH | 201671234 - (MA) WEST SUBURBAN EYE SURGERY CENTER, LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54437 | $1140.00 | 1023399318 - CANDESCENT EYE SURGICENTER LLC | 452898656 | RI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54437 | $1151.00 | 1629152053 - ISLAND EYE SURGICENTER LLC | 113486191 - (NY) ISLAND EYE SURGICENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54437 | $2206.00 | 1316508252 - MINIMALLY INVASIVE SURGICENTER LLC | 842130499 - (FL) MINIMALLY INVASIVE SURGICENTER L | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54437 | $3100.00 | 1396120168 - STAMFORD ASC LLC | 465569848 - (CT) STAMFORD ASC LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54437 | $2523.00 | 1619245230 - AMBULATORY SURGICAL PAVILION AT ROBERT WOOD JOHNSON LLC | 800768614 - (NJ) AMBULATORY SURGICAL PAVILION AT ROBERT WOOD JOHNSON LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54437 | $1355.00 | 1063635506 - DESCHUTES EYE CLINIC INC, EYE SURGERY INSTITUTE | 931148247 - (OR) ORION EYE CENTER, LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54437 | $1616.00 | 1801343496 - TRADITION SURGERY CENTER, LLC | 364837780 - (FL) TRADITION SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 54437 | $1459.00 | 1043819873 - LONE TREE SURGERY CENTER, LLC | 851321160 - (CO) LONE TREE SURGERY CENTER LLC | CO | 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 54437 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 54437 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 54437 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 54437. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 54437 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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