Billing code 54001: Prepuce incisionMedicare rate & RVUs
Reports a dorsal or lateral incision of the foreskin with extensive release of adhesions, typically to relieve clinically significant preputial tightness.
Medicare pays $203.41 for 54001 nationally in the office and $129.60 in a hospital or facility. Local office rates run $181.89–$260.97.
Medicare rate · 54001
Prepuce incision
Swap in your local Medicare rate.
- Work RVUs
- 2.18
- Total RVUs
- 6.09
- Global days
- 010
National rate · 2026
$203.41
Office setting, before claim adjustments.
See every locality for 54001 → · Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 10 sections
What 54001 covers
A urologist or other qualified physician makes a dorsal or lateral incision in the foreskin and releases extensive adhesions between the foreskin and glans. This may be performed when tight or adherent foreskin prevents adequate retraction or causes related symptoms. The procedure preserves the foreskin; it is not a circumcision. It is performed in an office or facility setting, depending on the patient and the planned care.
Choose this code when the operative work includes extensive adhesion release, rather than an incision alone. The note should identify the indication, incision site, and extent of adhesions released. Medicare assigns a 10-day global period, which includes related postoperative visits during that period. When multiple procedures are performed 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. Medicare does not pay an assistant at surgery for this service; 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 54001 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$181.89 to $260.97
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $184.30 | $119.71 |
| Alaska* | $243.67 | $165.06 |
| Arizona | $198.34 | $126.82 |
| Arkansas | $181.89 | $118.49 |
| Atlanta | $207.39 | $132.39 |
| Austin | $209.58 | $131.48 |
| Bakersfield | $212.94 | $132.04 |
| Baltimore/Surr. Cntys | $215.59 | $136.38 |
| Beaumont | $191.83 | $124.66 |
| Brazoria | $200.92 | $127.76 |
| Chicago | $216.21 | $142.02 |
| Chico | $212.14 | $131.23 |
| Colorado | $210.09 | $131.55 |
| Connecticut | $216.12 | $136.62 |
| Dallas | $202.30 | $128.78 |
| Dc + Md/Va Suburbs | $230.00 | $143.05 |
| Delaware | $201.41 | $128.48 |
| Detroit | $205.34 | $134.11 |
| East St. Louis | $202.83 | $134.92 |
| El Centro | $212.18 | $131.28 |
| Fort Lauderdale | $212.28 | $137.50 |
| Fort Worth | $201.20 | $128.42 |
| Fresno | $212.14 | $131.23 |
| Galveston | $201.59 | $128.29 |
| Hanford-Corcoran | $212.14 | $131.23 |
| Hawaii, Guam | $216.27 | $132.34 |
| Houston | $206.53 | $133.23 |
| Idaho | $188.93 | $121.02 |
| Indiana | $189.90 | $121.47 |
| Iowa | $187.64 | $120.10 |
| Kansas | $187.27 | $120.54 |
| Kentucky | $189.15 | $123.53 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $225.62 | $138.29 |
| Madera | $212.14 | $131.23 |
| Manhattan | $233.05 | $147.28 |
| Merced | $212.14 | $131.23 |
| Metropolitan Boston | $228.99 | $140.85 |
| Metropolitan Kansas City | $195.79 | $126.47 |
| Metropolitan Philadelphia | $211.45 | $134.60 |
| Metropolitan St. Louis | $197.59 | $127.32 |
| Miami | $222.19 | $145.34 |
| Minnesota | $200.59 | $124.63 |
| Mississippi | $184.16 | $120.60 |
| Modesto | $212.14 | $131.23 |
| Montana** | $203.39 | $129.58 |
| Napa | $242.22 | $144.93 |
| Nebraska | $188.44 | $120.31 |
| Nevada** | $202.03 | $128.14 |
| New Hampshire | $207.27 | $130.43 |
| New Mexico | $195.13 | $127.44 |
| New Orleans | $197.46 | $128.00 |
| North Carolina | $192.01 | $123.14 |
| North Dakota** | $198.05 | $124.24 |
| Northern Nj | $228.06 | $142.44 |
| Nyc Suburbs/Long Island | $238.78 | $151.01 |
| Ohio | $192.91 | $125.51 |
| Oklahoma | $188.39 | $122.47 |
| Oxnard-Thousand Oaks-Ventura | $224.18 | $136.93 |
| Portland | $215.76 | $133.75 |
| Poughkpsie/N Nyc Suburbs | $220.13 | $139.30 |
| Puerto Rico | $204.61 | $129.99 |
| Queens | $234.19 | $146.93 |
| Redding | $212.14 | $131.23 |
| Rest Of California | $212.14 | $131.23 |
| Rest Of Florida | $202.60 | $132.03 |
| Rest Of Georgia | $192.01 | $126.17 |
| Rest Of Illinois | $197.91 | $130.52 |
| Rest Of Louisiana | $189.05 | $123.72 |
| Rest Of Maine | $190.28 | $122.37 |
| Rest Of Maryland | $204.86 | $130.16 |
| Rest Of Massachusetts | $209.19 | $131.46 |
| Rest Of Michigan | $194.00 | $126.60 |
| Rest Of Missouri | $186.40 | $122.77 |
| Rest Of New Jersey | $218.38 | $137.78 |
| Rest Of New York | $194.65 | $124.53 |
| Rest Of Oregon | $200.25 | $126.73 |
| Rest Of Pennsylvania | $192.95 | $125.18 |
| Rest Of Texas | $196.34 | $126.28 |
| Rest Of Washington | $208.65 | $130.92 |
| Rhode Island | $207.83 | $131.58 |
| Riverside-San Bernardino-Ontario | $215.07 | $134.17 |
| Sacramento-Roseville-Folsom | $221.67 | $135.82 |
| Salinas | $220.82 | $135.26 |
| San Diego-Chula Vista-Carlsbad | $225.30 | $137.01 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $255.30 | $151.22 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $254.99 | $150.91 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $260.97 | $154.53 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $259.72 | $153.28 |
| San Luis Obispo-Paso Robles | $217.36 | $133.29 |
| Santa Cruz-Watsonville | $226.90 | $137.21 |
| Santa Maria-Santa Barbara | $221.45 | $135.38 |
| Santa Rosa-Petaluma | $229.13 | $138.49 |
| Seattle (King Cnty) | $233.00 | $142.43 |
| South Carolina | $192.82 | $124.61 |
| South Dakota** | $197.42 | $123.61 |
| Southern Maine | $198.99 | $125.84 |
| Stockton | $212.14 | $131.23 |
| Suburban Chicago | $214.17 | $138.36 |
| Tennessee | $188.17 | $121.07 |
| Utah | $195.20 | $125.81 |
| Vallejo | $241.78 | $144.49 |
| Vermont | $197.74 | $124.66 |
| Virgin Islands | $204.61 | $129.99 |
| Virginia | $198.69 | $126.13 |
| Visalia | $212.14 | $131.23 |
| West Virginia | $191.37 | $127.23 |
| Wisconsin | $192.06 | $121.35 |
| Wyoming** | $201.07 | $127.25 |
| Yuba City | $212.14 | $131.23 |
54001 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$181.89
$243.67
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $243.67 | 1 |
| AL | $184.30 | 1 |
| AR | $181.89 | 1 |
| AZ | $198.34 | 1 |
| CA | $212.14–$260.97 | 29 |
| CO | $210.09 | 1 |
| CT | $216.12 | 1 |
| DC | $230.00 | 1 |
| DE | $201.41 | 1 |
| FL | $202.60–$222.19 | 3 |
| GA | $192.01–$207.39 | 2 |
| GU | $216.27 | 1 |
| HI | $216.27 | 1 |
| IA | $187.64 | 1 |
| ID | $188.93 | 1 |
| IL | $197.91–$216.21 | 4 |
| IN | $189.90 | 1 |
| KS | $187.27 | 1 |
| KY | $189.15 | 1 |
| LA | $189.05–$197.46 | 2 |
| MA | $209.19–$228.99 | 2 |
| MD | $204.86–$230.00 | 3 |
| ME | $190.28–$198.99 | 2 |
| MI | $194.00–$205.34 | 2 |
| MN | $200.59 | 1 |
| MO | $186.40–$197.59 | 3 |
| MS | $184.16 | 1 |
| MT | $203.39 | 1 |
| NC | $192.01 | 1 |
| ND | $198.05 | 1 |
| NE | $188.44 | 1 |
| NH | $207.27 | 1 |
| NJ | $218.38–$228.06 | 2 |
| NM | $195.13 | 1 |
| NV | $202.03 | 1 |
| NY | $194.65–$238.78 | 5 |
| OH | $192.91 | 1 |
| OK | $188.39 | 1 |
| OR | $200.25–$215.76 | 2 |
| PA | $192.95–$211.45 | 2 |
| PR | $204.61 | 1 |
| RI | $207.83 | 1 |
| SC | $192.82 | 1 |
| SD | $197.42 | 1 |
| TN | $188.17 | 1 |
| TX | $191.83–$209.58 | 8 |
| UT | $195.20 | 1 |
| VA | $198.69–$230.00 | 2 |
| VI | $204.61 | 1 |
| VT | $197.74 | 1 |
| WA | $208.65–$233.00 | 2 |
| WI | $192.06 | 1 |
| WV | $191.37 | 1 |
| WY | $201.07 | 1 |
How the 54001 rate is calculated
Each of 54001’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 · 54001
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.18Practice expense 3.64Malpractice 0.27
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 54001
54001 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 54001
Prepuce incision
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 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) | 1 | Not paid (statutory restriction). |
| 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 · 54001
Prepuce incision
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
54001 without 51 · national office
$203.41
Prepuce incision
54001-51 · Second procedure: 50%
$101.71
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%).
54001 compared with similar codes
Compare codes
54001 vs 54000 vs 54161: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 54000Dorsal slit
- 54000 is for a preputial incision without extensive adhesion release. Report 54001 when extensive lysis of adhesions is part of the procedure.
- 54161Circumcision
- 54161 describes circumcision by surgical excision for a patient outside the newborn age group. Choose it when foreskin removal is performed, rather than an incision with adhesion release.
54001 billing questions
How does this differ from 54000?
Use 54001 when the procedure includes extensive release of adhesions. Code 54000 describes a preputial incision without that extensive adhesion work.
Is this a circumcision?
No. The procedure releases the foreskin by incision and extensive adhesion lysis while preserving it. If the planned procedure removes the foreskin, consider the applicable circumcision code instead.
What documentation supports 54001?
Document the clinical indication, incision location, and the extensive adhesions released. The note should make clear why the work goes beyond an incision alone.
Are postoperative visits included?
Related postoperative visits during the 10-day global period are included in the procedure's global package.
Can modifier 50 or an assistant surgeon be reported?
Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for this service.
How are other procedures in the same session handled?
The highest-valued procedure is paid in full, and other procedures performed in the same session are subject to the standard 50% multiple-procedure reduction.
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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