FeeBase
Log inGet started
Menu

CPT code 54235: Penile injection, pharmacologic agent2026 Medicare rate & RVUs in King County, WA

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 King County, WA, Medicare pays $107.48 for 54235 in the office and $74.69 when it’s performed in a hospital or facility.

$107.48Office (non-facility)
$74.69Hospital or facility
+13.3%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 King County, WA
  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 King County, WA 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. King County, WA pays $107.48. The RVUs are the same everywhere; the geographic indexes change the dollars.

54235 in King County, WA vs other payment areas
  1. King County, WA · this page$107.48
  2. Rest of Washington · Washington$96.87−$10.61
  3. Los Angeles, CA · California$104.12−$3.36
  4. Washington, DC area · District of Columbia$106.61−$0.87
  5. Miami, FL · Florida$104.61−$2.87
  6. Chicago, IL · Illinois$101.87−$5.61
  7. Manhattan, NY · New York$108.55+$1.07

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

Every other payment area

54235 in every other Medicare payment locality
Payment localityOfficeFacility
AlaskaAlaska$115.30$86.85
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

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 King County, WA 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

108

Locality
King County, WA
Physician work
1.050
Practice expense
1.227
Malpractice
0.817
Office calculation for 54235 in King County, WA
ComponentRVULocality factorAdjusted
Physician work1.16× 1.0501.2180
Practice expense1.53× 1.2271.8773
Malpractice0.15× 0.8170.1225
Total RVUs3.2179
Conversion factor× 33.4009

Office rate, King County, WA$107.48

Office: (1.16 × 1.05 + 1.53 × 1.227 + 0.15 × 0.817) × $33.4009 = $107.48

Facility: (1.16 × 1.05 + 0.73 × 1.227 + 0.15 × 0.817) × $33.4009 = $74.69

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, King County, WA
Used instead
54231Cavernosometry, dynamic hemodynamic studyDynamic cavernosometry provides pressure measurements during a more involved erectile-function evaluation.$167.60
54230Cavernosography, contrast injectionCavernosography evaluates penile vascular anatomy with contrast imaging rather than pharmacologic injection alone.$125.58
54240Penile plethysmography, stimulus-response measurementPenile plethysmography is a separate physiologic testing approach used in sexual-function evaluation.$128.63

How 54235 has changed in King County, WA

54235 · Office / nonfacility

$107.48

Effective 2026-10-01

The base rate is $6.88 higher than on 2025-10-01, moving from $100.60 to $107.48 (6.8%).

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

    $100.60changed to$107.48

    • 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 1.043 changed to 1.050
    • Practice expense GPCI 1.220 changed to 1.227
    • Malpractice GPCI 0.853 changed to 0.817

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $101.62changed to$100.60

    • 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

    $99.96changed to$101.62

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $100.58changed to$99.96

    • 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 1.039 changed to 1.043
    • Practice expense GPCI 1.207 changed to 1.220
    • Malpractice GPCI 0.815 changed to 0.853

  5. January 1, 2023

    RVU23A

    $98.36changed to$100.58

    • 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 1.036 changed to 1.039
    • Practice expense GPCI 1.194 changed to 1.207
    • Malpractice GPCI 0.776 changed to 0.815

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $99.30changed to$98.36

    • 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

    $99.38changed to$99.30

    • 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 1.031 changed to 1.036
    • Practice expense GPCI 1.170 changed to 1.194
    • Malpractice GPCI 0.854 changed to 0.776

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $99.62changed to$99.38

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.24 changed to 1.21
    • Work GPCI 1.027 changed to 1.031
    • Practice expense GPCI 1.146 changed to 1.170
    • Malpractice GPCI 0.931 changed to 0.854

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $102.40changed to$99.62

    • 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

    $99.61changed to$102.40

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.27 changed to 1.31
    • Work GPCI 1.026 changed to 1.027
    • Practice expense GPCI 1.151 changed to 1.146
    • Malpractice GPCI 0.713 changed to 0.931

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $97.67changed to$99.61

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.25 changed to 1.27
    • Work GPCI 1.025 changed to 1.026
    • Practice expense GPCI 1.155 changed to 1.151
    • Malpractice GPCI 0.495 changed to 0.713

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $98.20changed to$97.67

    • 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

    $97.71changed to$98.20

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $97.49changed to$97.71

    • 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
    • Practice expense GPCI 1.150 changed to 1.155
    • Malpractice GPCI 0.688 changed to 0.495

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $96.56changed to$97.49

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 1.33 changed to 1.24
    • Practice expense GPCI 1.144 changed to 1.150
    • Malpractice GPCI 0.881 changed to 0.688

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $96.56

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$107.48$74.69RVU26D
2026-07-01$107.48$74.69RVU26C
2026-04-01$107.48$74.69RVU26B
2026-01-01$107.48$74.69RVU26A
2025-10-01$100.60$79.68RVU25D
2025-07-01$100.60$79.68RVU25C
2025-04-01$100.60$79.68RVU25B
2025-01-01$100.60$79.68RVU25A
2024-10-01$101.62$80.91RVU24D
2024-07-01$101.62$80.91RVU24C
2024-04-01$101.62$80.91RVU24B
2024-03-09$101.62$80.91RVU24AR
2024-01-01$99.96$79.59RVU24A
2023-10-01$100.58$80.54RVU23D
2023-07-01$100.58$80.54RVU23C
2023-04-01$100.58$80.54RVU23B
2023-01-01$100.58$80.54RVU23A
2022-10-01$98.36$78.94RVU22D
2022-07-01$98.36$78.94RVU22C
2022-04-01$98.36$78.94RVU22B
2022-01-01$98.36$78.94RVU22A
2021-10-01$99.30$79.72RVU21D
2021-07-01$99.30$79.72RVU21C
2021-04-01$99.30$79.72RVU21B
2021-01-01$99.30$79.72RVU21A
2020-10-01$99.38$81.22RVU20D
2020-07-01$99.38$81.22RVU20C
2020-04-01$99.38$81.22RVU20B
2020-01-01$99.38$81.22RVU20A
2019-10-01$99.62$81.03RVU19D
2019-07-01$99.62$81.03RVU19C
2019-04-01$99.62$81.03RVU19B
2019-01-01$99.62$81.03RVU19A
2018-10-01$102.40$81.77RVU18D
2018-07-01$102.40$81.77RVU18C
2018-04-01$102.40$81.77RVU18B
2018-01-01$102.40$81.77RVU18AR1
2017-10-01$99.61$80.19RVU17D
2017-07-01$99.61$80.19RVU17C
2017-04-01$99.61$80.19RVU17B
2017-01-01$99.61$80.19RVU17A
2016-10-01$97.67$78.65RVU16D
2016-07-01$97.67$78.65RVU16C
2016-04-01$97.67$78.65RVU16B
2016-01-01$97.67$78.65RVU16A
2015-10-01$98.20$79.11RVU15D
2015-07-01$98.20$79.11RVU15C
2015-04-01$97.71$78.71RVU15B
2015-01-01$97.71$78.71RVU15A
2014-10-01$97.49$78.95RVU14D
2014-07-01$97.49$78.95RVU14C
2014-04-01$97.49$78.95RVU14B
2014-01-01$97.49$78.95RVU14A
2013-10-01$96.56$77.49RVU13D
2013-07-01$96.56$77.49RVU13C
2013-04-01$96.56$77.49RVU13B
2013-01-01$96.56$77.49RVU13AR

Price 54235 for an earlier date of service

Where the King County, WA rate applies

King County, WA is a Medicare payment area, not a city. Our Census mapping connects it to 63 cities and communities in Washington. Some span more than one payment area; confirm with the service ZIP.

  • Seattle
  • Algona
  • Ames Lake
  • 54235 in Auburn · multiple payment areas
  • Baring
  • Beaux Arts Village
  • Bellevue
  • Black Diamond

Browse all communities in Washington

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 King County, WAGPCI2026.csv, line 108 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 54235 pays in King County, WA?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets · Coming soon

Put 54235 and the rest of your codes on one sheet

Your codes at your locality, with payer contracts beside Medicare.

Join the waitlist