Billing code 54160: CircumcisionMedicare rate & RVUs

Medicare pays $228.46 for 54160 nationally in the office and $132.27 in a hospital or facility. Local office rates run $204.09–$292.07.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 54160 covers

This code covers circumcision of a neonate by surgical excision of the foreskin, rather than using a clamp or other device or performing a dorsal slit. It is typically performed by a physician such as a pediatrician, family physician, or urologist in a hospital nursery or outpatient setting. The operative approach, not simply the fact that a circumcision occurred, distinguishes this service from circumcision codes for other techniques or age groups.

Select the code based on the patient’s age and the documented method. The record should identify the neonate’s age and describe the excision technique. CMS assigns a 10-day global period, so related postoperative visits during that 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% reduction. Modifier 50 is inappropriate for this service. CMS does not pay for 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 54160 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

54160 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 54160 rate is calculated

Each of 54160’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.

Payment rules and modifiers for 54160

54160 has a 10-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

54160 compared with similar codes

How to choose

54150Circumcision

Choose 54150 for circumcision using a clamp or other device with a regional block; 54160 is the neonatal surgical-excision service.

54161Circumcision

Both describe surgical-excision circumcision, but 54161 applies to the older age category rather than a neonate.

54164Frenulotomy

54164 describes division of the penile frenulum, not removal of the foreskin. It is relevant only when that separate service is performed.

Codes related to 54160

Related codes aren’t interchangeable: bill the code that matches the service 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

Open CMS sourceHow we calculate rates