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CPT code 54235: Penile injection, pharmacologic agent2026 Medicare rate & RVUs in Rhode Island

Reports injection of a pharmacologic agent into the corpora cavernosa, commonly to induce an erection during evaluation of erectile dysfunction.

CMS RVU26DEffective Oct 1, 2026One payment locality15.7K Medicare services in 2024

In Rhode Island, Medicare pays $96.74 for 54235 in the office and $69.14 when it’s performed in a hospital or facility.

$96.74Office (non-facility)
$69.14Hospital or facility
+2.0%vs the national office rate ($94.86)

Check a contract rate as a % of Medicare · 54235 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 54235 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Rhode Island
  2. What 54235 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 54235 covers

A clinician injects a pharmacologic agent into the corpora cavernosa to produce an erection, commonly as part of an evaluation for erectile dysfunction. Urologists typically perform the procedure in an office or outpatient setting. The service centers on administration of the agent into the erectile tissue; it is distinct from injecting medication into a Peyronie’s plaque or irrigating the corpora for priapism.

Documentation should identify the clinical reason, the agent administered, the injection, and the observed response when assessed. The code has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery for it; co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Rhode Island compares for 54235

Across 109 of 109 payment localities, the office rate for 54235 runs from $85.22 in Arkansas to $119.38 in San Benito County, CA. Rhode Island pays $96.74. The RVUs are the same everywhere; the geographic indexes change the dollars.

54235 in Rhode Island vs other payment areas
  1. Rhode Island · this page$96.74
  2. Los Angeles, CA · California$104.12+$7.38
  3. Washington, DC area · District of Columbia$106.61+$9.87
  4. Miami, FL · Florida$104.61+$7.87
  5. Chicago, IL · Illinois$101.87+$5.13
  6. Manhattan, NY · New York$108.55+$11.81
  7. Alaska · Alaska$115.30+$18.56

Other areas in Rhode Island first, then benchmark localities. Bars start at $0.

Every other payment area

54235 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$86.30$62.92
ArkansasArkansas$85.22$62.27
ArizonaArizona$92.55$66.66
Bakersfield, CACalifornia$98.54$69.26
Chico, CACalifornia$98.10$68.81
El Centro, CACalifornia$98.12$68.84
Fresno, CACalifornia$98.10$68.81
Hanford, CACalifornia$98.10$68.81

54235 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$85.22

$115.30

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
54235 office rate range by state
State / territoryOffice rate rangeLocalities
AK$115.301
AL$86.301
AR$85.221
AZ$92.551
CA$98.10–$119.3829
CO$97.501
CT$100.621
DC$106.611
DE$93.931
FL$95.13–$104.613
GA$90.30–$96.802
GU$99.751
HI$99.751
IA$87.491
ID$88.131
IL$93.23–$101.874
IN$88.551
KS$87.471
KY$88.761
LA$88.77–$92.522
MA$97.17–$105.812
MD$95.45–$106.613
ME$88.88–$92.552
MI$91.06–$96.512
MN$92.811
MO$87.68–$92.423
MS$86.451
MT$94.851
NC$89.631
ND$91.881
NE$87.811
NH$96.331
NJ$101.60–$105.822
NM$91.621
NV$94.071
NY$90.82–$111.295
OH$90.451
OK$88.271
OR$93.17–$99.872
PA$90.39–$98.622
PR$95.351
RI$96.741
SC$90.221
SD$91.531
TN$87.891
TX$89.90–$97.338
UT$91.281
VA$92.52–$106.612
VI$95.351
VT$91.871
WA$96.87–$107.482
WI$89.251
WV$90.321
WY$93.561

See 54235 in every payment locality

How the 54235 rate is calculated

Each of 54235’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 54235

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.16

1.16 RVUs× 1.000 GPCI

Practice expense1.53

1.53 RVUs× 1.000 GPCI

Malpractice0.15

0.15 RVUs× 1.000 GPCI

Adjusted RVUs

2.8400

Conversion factor

$33.4009

Medicare rate

$94.86

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Rhode Island inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

6,265

Code
54235
Physician work
1.16
Practice expense
1.53
Malpractice
0.15

GPCI2026.csv

92

Locality
Rhode Island
Physician work
1.019
Practice expense
1.033
Malpractice
0.892
Office calculation for 54235 in Rhode Island
ComponentRVULocality factorAdjusted
Physician work1.16× 1.0191.1820
Practice expense1.53× 1.0331.5805
Malpractice0.15× 0.8920.1338
Total RVUs2.8963
Conversion factor× 33.4009

Office rate, Rhode Island$96.74

Office: (1.16 × 1.019 + 1.53 × 1.033 + 0.15 × 0.892) × $33.4009 = $96.74

Facility: (1.16 × 1.019 + 0.73 × 1.033 + 0.15 × 0.892) × $33.4009 = $69.14

Open 54235 in the RVU calculator

Payment rules and modifiers for 54235

The CMS indicators that decide how 54235 is paid alongside other services.

CMS payment indicators · 54235

Penile injection, pharmacologic agent

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

54235 without 51 · national office

$94.86

Penile injection, pharmacologic agent

54235-51 · Second procedure: 50%

$47.43

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

Codes related to 54235

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 54235
CodeHow it relatesOffice range, Rhode Island
Used instead
54231Cavernosometry, dynamic hemodynamic studyDynamic cavernosometry provides pressure measurements during a more involved erectile-function evaluation.$151.78
54230Cavernosography, contrast injectionCavernosography evaluates penile vascular anatomy with contrast imaging rather than pharmacologic injection alone.$112.79
54240Penile plethysmography, stimulus-response measurementPenile plethysmography is a separate physiologic testing approach used in sexual-function evaluation.$115.43

How 54235 has changed in Rhode Island

54235 · Office / nonfacility

$96.74

Effective 2026-10-01

The base rate is $5.17 higher than on 2025-10-01, moving from $91.57 to $96.74 (5.6%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $91.57changed to$96.74

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.19 changed to 1.16
    • Practice expense RVU 1.42 changed to 1.53
    • Malpractice RVU 0.16 changed to 0.15
    • Work GPCI 1.025 changed to 1.019
    • Practice expense GPCI 1.039 changed to 1.033
    • Malpractice GPCI 0.849 changed to 0.892

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $92.57changed to$91.57

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 1.38 changed to 1.42
    • Malpractice RVU 0.15 changed to 0.16

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $91.06changed to$92.57

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $93.22changed to$91.06

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 1.32 changed to 1.38
    • Malpractice RVU 0.17 changed to 0.15
    • Work GPCI 1.023 changed to 1.025
    • Practice expense GPCI 1.044 changed to 1.039
    • Malpractice GPCI 0.915 changed to 0.849

  5. January 1, 2023

    RVU23A

    $92.18changed to$93.22

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 1.27 changed to 1.32
    • Malpractice RVU 0.12 changed to 0.17
    • Work GPCI 1.021 changed to 1.023
    • Practice expense GPCI 1.048 changed to 1.044
    • Malpractice GPCI 0.981 changed to 0.915

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $93.26changed to$92.18

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 1.26 changed to 1.27
    • Malpractice RVU 0.14 changed to 0.12

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $94.43changed to$93.26

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.21 changed to 1.26
    • Malpractice RVU 0.13 changed to 0.14
    • Work GPCI 1.024 changed to 1.021
    • Practice expense GPCI 1.049 changed to 1.048
    • Malpractice GPCI 0.990 changed to 0.981

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $95.65changed to$94.43

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.24 changed to 1.21
    • Work GPCI 1.027 changed to 1.024
    • Practice expense GPCI 1.050 changed to 1.049
    • Malpractice GPCI 0.999 changed to 0.990

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $98.19changed to$95.65

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.31 changed to 1.24

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $95.82changed to$98.19

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.27 changed to 1.31
    • Work GPCI 1.025 changed to 1.027
    • Practice expense GPCI 1.052 changed to 1.050
    • Malpractice GPCI 0.879 changed to 0.999

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $94.20changed to$95.82

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.25 changed to 1.27
    • Work GPCI 1.022 changed to 1.025
    • Practice expense GPCI 1.053 changed to 1.052
    • Malpractice GPCI 0.759 changed to 0.879

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $94.82changed to$94.20

    • Conversion factor 35.9335 changed to 35.8043
    • Malpractice RVU 0.14 changed to 0.13

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $94.35changed to$94.82

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $94.09changed to$94.35

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 1.24 changed to 1.25
    • Malpractice RVU 0.11 changed to 0.14
    • Work GPCI 1.020 changed to 1.022
    • Malpractice GPCI 0.973 changed to 0.759

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    No ratechanged to$94.09

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$96.74$69.14RVU26D
2026-07-01$96.74$69.14RVU26C
2026-04-01$96.74$69.14RVU26B
2026-01-01$96.74$69.14RVU26A
2025-10-01$91.57$73.76RVU25D
2025-07-01$91.57$73.76RVU25C
2025-04-01$91.57$73.76RVU25B
2025-01-01$91.57$73.76RVU25A
2024-10-01$92.57$74.93RVU24D
2024-07-01$92.57$74.93RVU24C
2024-04-01$92.57$74.93RVU24B
2024-03-09$92.57$74.93RVU24AR
2024-01-01$91.06$73.71RVU24A
2023-10-01$93.22$75.89RVU23D
2023-07-01$93.22$75.89RVU23C
2023-04-01$93.22$75.89RVU23B
2023-01-01$93.22$75.89RVU23A
2022-10-01$92.18$75.13RVU22D
2022-07-01$92.18$75.13RVU22C
2022-04-01$92.18$75.13RVU22B
2022-01-01$92.18$75.13RVU22A
2021-10-01$93.26$76.08RVU21D
2021-07-01$93.26$76.08RVU21C
2021-04-01$93.26$76.08RVU21B
2021-01-01$93.26$76.08RVU21A
2020-10-01$94.43$78.15RVU20D
2020-07-01$94.43$78.15RVU20C
2020-04-01$94.43$78.15RVU20B
2020-01-01$94.43$78.15RVU20A
2019-10-01$95.65$78.62RVU19D
2019-07-01$95.65$78.62RVU19C
2019-04-01$95.65$78.62RVU19B
2019-01-01$95.65$78.62RVU19A
2018-10-01$98.19$79.29RVU18D
2018-07-01$98.19$79.29RVU18C
2018-04-01$98.19$79.29RVU18B
2018-01-01$98.19$79.29RVU18AR1
2017-10-01$95.82$78.08RVU17D
2017-07-01$95.82$78.08RVU17C
2017-04-01$95.82$78.08RVU17B
2017-01-01$95.82$78.08RVU17A
2016-10-01$94.20$76.86RVU16D
2016-07-01$94.20$76.86RVU16C
2016-04-01$94.20$76.86RVU16B
2016-01-01$94.20$76.86RVU16A
2015-10-01$94.82$77.41RVU15D
2015-07-01$94.82$77.41RVU15C
2015-04-01$94.35$77.03RVU15B
2015-01-01$94.35$77.03RVU15A
2014-10-01$94.09$77.12RVU14D
2014-07-01$94.09$77.12RVU14C
2014-04-01$94.09$77.12RVU14B
2014-01-01$94.09$77.12RVU14A
2013-10-01Rate data unavailableRate data unavailableRVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 54235 for an earlier date of service

Where the Rhode Island rate applies

Rhode Island is a Medicare payment area, not a city. Our Census mapping connects it to 36 cities and communities in Rhode Island. Some span more than one payment area; confirm with the service ZIP.

  • Ashaway
  • Bradford
  • Carolina
  • Central Falls
  • Charlestown
  • Chepachet
  • Clayville
  • Cranston

Browse all communities in Rhode Island

54235 billing questions

How does this differ from a Peyronie’s disease injection?

54235 describes pharmacologic injection into the corpora cavernosa, commonly to assess erectile response. Code 54200 is for injection treatment directed at Peyronie’s disease.

Is modifier 50 appropriate when both sides are injected?

No. The CMS bilateral adjustment does not apply to 54235, and modifier 50 is inappropriate.

What same-day care is included?

The 0-day global period includes same-day preoperative and postoperative care. The pharmacologic injection itself is the service reported.

How are other procedures handled in the same session?

The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction. The rule applies when procedures are performed in the same session.

Can an assistant or another surgeon be reported?

Medicare does not pay an assistant at surgery for 54235. Co-surgeons and team surgery are not permitted.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 54235PPRRVU2026_Oct_nonQPP.csv, line 6,265 (RVU26D)
Geographic factors for Rhode IslandGPCI2026.csv, line 92 (RVU26D)

Open CMS sourceHow we calculate rates

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