Billing code 54056: Penile lesion destructionMedicare rate & RVUs
Report this service when a clinician treats one or more penile lesions by freezing, such as condylomata, rather than by another destruction method.
Medicare pays $143.96 for 54056 nationally in the office and $99.20 in a hospital or facility. Local office rates run $128.10–$189.68.
Medicare rate · 54056
Penile lesion destruction
Swap in your local Medicare rate.
- Work RVUs
- 1.26
- Total RVUs
- 4.31
- Global days
- 010
National rate · 2026
$143.96
Office setting, before claim adjustments.
See every locality for 54056 → · 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 54056 covers
This service uses cryosurgery to freeze and destroy one or more lesions on the penis. Common examples include condylomata and other localized lesions suitable for this technique. Urologists, dermatologists, and other clinicians who treat genital lesions may perform it, commonly in an office setting. The selected code reflects the penile site and the cryosurgical method, not simply the presence of a lesion or the number treated.
Document the treated site or sites, the cryosurgical technique, and the clinical findings supporting treatment. Related postoperative visits during the 10-day global period are included. 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 for this code. Medicare does not pay an assistant at surgery, and 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 54056 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
$128.10 to $189.68
109 of 109 payment localities
54056 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.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$128.10
$170.85
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 | $169.39 | 1 |
| AL | $129.88 | 1 |
| AR | $128.10 | 1 |
| AZ | $140.31 | 1 |
| CA | $152.02–$189.68 | 29 |
| CO | $149.75 | 1 |
| CT | $153.22 | 1 |
| DC | $164.08 | 1 |
| DE | $142.56 | 1 |
| FL | $141.85–$154.60 | 3 |
| GA | $134.26–$146.52 | 2 |
| GU | $155.49 | 1 |
| HI | $155.49 | 1 |
| IA | $133.05 | 1 |
| ID | $133.87 | 1 |
| IL | $137.92–$150.36 | 4 |
| IN | $134.61 | 1 |
| KS | $132.44 | 1 |
| KY | $132.76 | 1 |
| LA | $132.56–$138.79 | 2 |
| MA | $148.92–$164.13 | 2 |
| MD | $145.19–$164.08 | 3 |
| ME | $134.51–$141.48 | 2 |
| MI | $136.03–$143.52 | 2 |
| MN | $143.73 | 1 |
| MO | $130.39–$139.29 | 3 |
| MS | $129.27 | 1 |
| MT | $143.95 | 1 |
| NC | $135.86 | 1 |
| ND | $141.38 | 1 |
| NE | $133.75 | 1 |
| NH | $147.41 | 1 |
| NJ | $155.04–$162.51 | 2 |
| NM | $136.74 | 1 |
| NV | $143.33 | 1 |
| NY | $137.79–$168.81 | 5 |
| OH | $135.51 | 1 |
| OK | $132.55 | 1 |
| OR | $142.28–$154.35 | 2 |
| PA | $135.72–$149.55 | 2 |
| PR | $144.97 | 1 |
| RI | $147.51 | 1 |
| SC | $135.89 | 1 |
| SD | $141.07 | 1 |
| TN | $133.07 | 1 |
| TX | $134.87–$149.20 | 8 |
| UT | $137.66 | 1 |
| VA | $141.02–$164.08 | 2 |
| VI | $144.97 | 1 |
| VT | $140.84 | 1 |
| WA | $148.64–$167.41 | 2 |
| WI | $136.86 | 1 |
| WV | $133.05 | 1 |
| WY | $142.83 | 1 |
How the 54056 rate is calculated
Each of 54056’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 · 54056
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.26Practice expense 2.92Malpractice 0.13
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 54056
54056 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 54056
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 · 54056
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
54056 without 51 · national office
$143.96
Penile lesion destruction
54056-51 · Second procedure: 50%
$71.98
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%).
54056 compared with similar codes
Compare codes
54056 vs 54050 vs 54055 vs 54057 vs 54065: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 54050Penile lesion destruction
- 54050 describes chemical destruction of penile lesions. Choose 54056 when the method is cryosurgery.
- 54055Penile lesion destruction
- 54055 is for electrosurgical destruction of penile lesions; 54056 is for cryosurgical treatment.
- 54057Penile lesion treatment
- 54057 describes laser surgery for penile lesions. It is not the appropriate choice when lesions are frozen.
- 54065Penile lesion destruction
- 54065 is used for extensive penile lesion destruction. 54056 describes cryosurgery; select based on the service performed and its extent.
54056 billing questions
When should 54056 be chosen over 54050 or 54055?
Use 54056 when the penile lesion is destroyed by cryosurgery. Codes 54050 and 54055 describe chemical and electrosurgical destruction, respectively.
Does the code cover more than one penile lesion?
The service covers one or more penile lesions treated with cryosurgery. Document the treated sites and the technique used.
Are related postoperative visits separately included?
Related postoperative visits during the 10-day global period are included in the procedure.
Should modifier 50 be appended for lesions on both sides?
No. The descriptor or anatomy makes modifier 50 inappropriate for this code.
How does Medicare handle another procedure performed in the same session?
The highest-valued procedure is paid in full; other procedures in the same session are subject to the standard 50% multiple-procedure reduction. Medicare does not pay an assistant at surgery, and 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
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