Billing code 54055: Penile lesion destructionMedicare rate & RVUs
Reports extensive destruction of penile lesions, such as condyloma, when treatment goes beyond simple chemical destruction of a limited lesion.
Medicare pays $139.28 for 54055 nationally in the office and $86.84 in a hospital or facility. Local office rates run $123.78–$183.08.
Medicare rate · 54055
Penile lesion destruction
Swap in your local Medicare rate.
- Work RVUs
- 1.22
- Total RVUs
- 4.17
- Global days
- 010
National rate · 2026
$139.28
Office setting, before claim adjustments.
See every locality for 54055 → · 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 54055 covers
This service covers extensive destruction of lesions on the penis, commonly condyloma (genital warts). A urologist, dermatologist, or other qualified clinician may perform it in an office or procedure setting using an ablative approach such as electrosurgery. The extent of treatment, rather than a particular lesion count, distinguishes it from simple chemical destruction; technique-specific cryosurgery and laser codes are also available.
Report the service when the documented lesion burden and treatment support extensive destruction. Record the penile site, lesion distribution, method, and work performed. The service has 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% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery billing 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 54055 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
$123.78 to $183.08
109 of 109 payment localities
54055 rates by state
Office rate range in each state. Select a state to see its payment localities.
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Local rates. Clear comparisons.
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$123.78
$164.95
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 | $163.66 | 1 |
| AL | $125.52 | 1 |
| AR | $123.78 | 1 |
| AZ | $135.70 | 1 |
| CA | $146.81–$183.08 | 29 |
| CO | $144.75 | 1 |
| CT | $148.31 | 1 |
| DC | $158.72 | 1 |
| DE | $137.89 | 1 |
| FL | $137.50–$150.28 | 3 |
| GA | $130.04–$141.85 | 2 |
| GU | $150.17 | 1 |
| HI | $150.17 | 1 |
| IA | $128.48 | 1 |
| ID | $129.31 | 1 |
| IL | $133.75–$146.09 | 4 |
| IN | $130.03 | 1 |
| KS | $127.95 | 1 |
| KY | $128.47 | 1 |
| LA | $128.29–$134.38 | 2 |
| MA | $143.96–$158.65 | 2 |
| MD | $140.43–$158.72 | 3 |
| ME | $130.01–$136.71 | 2 |
| MI | $131.72–$139.20 | 2 |
| MN | $138.71 | 1 |
| MO | $126.21–$134.79 | 3 |
| MS | $125.02 | 1 |
| MT | $139.27 | 1 |
| NC | $131.31 | 1 |
| ND | $136.50 | 1 |
| NE | $129.15 | 1 |
| NH | $142.55 | 1 |
| NJ | $150.00–$157.18 | 2 |
| NM | $132.43 | 1 |
| NV | $138.59 | 1 |
| NY | $133.20–$163.64 | 5 |
| OH | $131.15 | 1 |
| OK | $128.20 | 1 |
| OR | $137.52–$149.15 | 2 |
| PA | $131.33–$144.77 | 2 |
| PR | $140.24 | 1 |
| RI | $142.65 | 1 |
| SC | $131.45 | 1 |
| SD | $136.18 | 1 |
| TN | $128.58 | 1 |
| TX | $130.50–$144.27 | 8 |
| UT | $133.17 | 1 |
| VA | $136.31–$158.72 | 2 |
| VI | $140.24 | 1 |
| VT | $136.03 | 1 |
| WA | $143.67–$161.77 | 2 |
| WI | $132.10 | 1 |
| WV | $129.00 | 1 |
| WY | $138.07 | 1 |
How the 54055 rate is calculated
Each of 54055’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 · 54055
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.22Practice expense 2.81Malpractice 0.14
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 54055
54055 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 54055
Penile lesion destruction
| 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 · 54055
Penile lesion destruction
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
54055 without 51 · national office
$139.28
Penile lesion destruction
54055-51 · Second procedure: 50%
$69.64
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%).
54055 compared with similar codes
Compare codes
54055 vs 54050 vs 54056 vs 54057 vs 54060: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 54050Penile lesion destruction
- 54050 is for simple chemical destruction. 54055 is selected for extensive destruction, supported by the treatment performed and documented extent.
- 54056Penile lesion destruction
- 54056 identifies cryosurgery for extensive penile lesions. Use 54055 when the service is extensive destruction by a method not identified by that technique-specific code.
- 54057Penile lesion treatment
- 54057 identifies laser surgery for extensive penile lesions. 54055 covers extensive destruction when laser surgery is not the specified method.
- 54060Penile lesion excision
- 54060 is for excision, removing the lesion. 54055 is for destroying it without reporting an excisional approach.
54055 billing questions
How does 54055 differ from 54050?
54055 is for extensive destruction. 54050 describes simple chemical destruction, so the documented extent and method help distinguish the services.
When should a technique-specific code be considered?
Use the applicable sibling when the service is specifically cryosurgery or laser surgery: 54056 identifies cryosurgery and 54057 identifies laser surgery.
Can 54055 be reported with excision code 54060?
The codes describe different approaches: 54055 destroys lesions, while 54060 removes them by excision. Documentation should show which approach was performed.
Are related postoperative visits separately reported during the global period?
Related postoperative visits during the 10-day global period are included in 54055.
Can modifier 50 or an assistant-at-surgery claim be used?
Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for 54055.
What documentation supports reporting 54055?
Document the penile site, lesion distribution, why treatment was extensive, the destruction method, and the work performed.
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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