CPT code 54420: Penile reconstruction, for injury2026 Medicare rate & RVUs in California
Reconstructive penile surgery for injury-related structural damage is reported when the operation goes beyond direct repair of an acute tear.
CMS doesn’t publish an office rate for 54420 in California.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 54420 covers
This operation reconstructs the penis after injury-related damage or deformity. A urologist typically performs it in a hospital or other surgical setting, using an operative approach tailored to the injured anatomy and the reconstructive goal. It is distinct from placing or revising a penile prosthesis and from a limited repair of an acute corporal tear.
Report the code when the operative record supports a plastic reconstructive procedure for penile injury. Document the injury, affected structures, resulting defect or deformity, and the work performed; a diagnosis of trauma alone does not establish that this reconstruction was done. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. 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% reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; 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.
Where 54420 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | Unavailable | $641.25 |
| Chico, CA | Unavailable | $636.69 |
| El Centro, CA | Unavailable | $636.95 |
| Fresno, CA | Unavailable | $636.69 |
| Hanford, CA | Unavailable | $636.69 |
| Los Angeles, CA | Unavailable | $668.74 |
| Madera, CA | Unavailable | $636.69 |
| Marin County, CA | Unavailable | $721.15 |
| Merced, CA | Unavailable | $636.69 |
| Modesto, CA | Unavailable | $636.69 |
| Napa, CA | Unavailable | $694.07 |
| Oxnard, CA | Unavailable | $661.20 |
| Redding, CA | Unavailable | $636.69 |
| Rest of California | Unavailable | $636.69 |
| Riverside, CA | Unavailable | $653.40 |
| Sacramento, CA | Unavailable | $656.51 |
| Salinas, CA | Unavailable | $653.77 |
| San Benito County, CA | Unavailable | $736.97 |
| San Diego, CA | Unavailable | $660.38 |
| San Francisco, CA | Unavailable | $719.40 |
| San Luis Obispo, CA | Unavailable | $644.49 |
| Santa Clara County, CA | Unavailable | $729.82 |
| Santa Cruz, CA | Unavailable | $659.89 |
| Santa Maria, CA | Unavailable | $653.82 |
| Santa Rosa, CA | Unavailable | $665.88 |
| Stockton, CA | Unavailable | $636.69 |
| Vallejo, CA | Unavailable | $691.55 |
| Visalia, CA | Unavailable | $636.69 |
| Yuba City, CA | Unavailable | $636.69 |
How the 54420 rate is calculated
Each of 54420’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 · 54420
RVUs × geographic indexes × conversion factor
Work12.08
12.08 RVUs× 1.000 GPCI
Practice expense5.43
5.43 RVUs× 1.000 GPCI
Malpractice1.54
1.54 RVUs× 1.000 GPCI
Adjusted RVUs
19.0500
Conversion factor
$33.4009
Medicare rate
$636.29
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 54420
54420 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 54420
Penile reconstruction, for injury
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 54420
Penile reconstruction, for injury
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
54420 without 51 · national facility
$636.29
Penile reconstruction, for injury
54420-51 · Second procedure: 50%
$318.15
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%).
54420 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 54437Corporal tear repairPenile fracture
- 54437 describes repair of a corporeal tear. Use 54420 when the operation is reconstructive surgery for injury-related penile damage, not simply repair of the tear.
- 54440Penile repair
- 54440 is a penile repair code. Choose 54420 when the operative service is plastic reconstruction for injury rather than the repair service documented for 54440.
- 54430Penile reconstructionPeyronie disease, with graft
- Both are penile plastic-operation codes, but the indication and work documented determine the correct code. Do not select 54420 unless the reconstruction is for injury.
- 54435Penile repairFracture repair
- This is another nearby penile revision code. Compare the specific indication and operative service rather than treating the codes as interchangeable.
54420 billing questions
How is this distinguished from repair of a corporal tear?
Use this code for reconstructive plastic surgery addressing injury-related penile damage. A procedure focused on repairing an acute corporeal tear is represented by 54437.
What documentation supports reporting this code?
Record the injury and its resulting anatomic damage or deformity, the reconstructive objective, and the operative work performed. The note should make clear why the service was reconstruction rather than a limited tear repair.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
What happens when another procedure is performed in the same session?
CMS applies the standard multiple-procedure reduction: the highest-valued procedure is paid in full, and other procedures are paid at 50%.
May an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons and team surgery are not permitted under the CMS rules for this code.
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
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