Billing code 54235: Penile injectionMedicare rate & RVUs
Reports injection of a pharmacologic agent into the corpora cavernosa, commonly to induce an erection during evaluation of erectile dysfunction.
Medicare pays $94.86 for 54235 nationally in the office and $68.14 in a hospital or facility. Local office rates run $85.22–$119.38.
Medicare rate · 54235
Penile injection
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- Work RVUs
- 1.16
- Total RVUs
- 2.84
- Global days
- 000
National rate · 2026
$94.86
Office setting, before claim adjustments.
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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 54235 covers
A clinician injects a pharmacologic agent into the corpora cavernosa to produce an erection, commonly as part of an evaluation for erectile dysfunction. Urologists typically perform the procedure in an office or outpatient setting. The service centers on administration of the agent into the erectile tissue; it is distinct from injecting medication into a Peyronie’s plaque or irrigating the corpora for priapism.
Documentation should identify the clinical reason, the agent administered, the injection, and the observed response when assessed. The code has a 0-day global period, so same-day preoperative and postoperative care is included. 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% multiple-procedure reduction. Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery for it; 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 54235 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
$85.22 to $119.38
109 of 109 payment localities
54235 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.
$85.22
$115.30
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 | $115.30 | 1 |
| AL | $86.30 | 1 |
| AR | $85.22 | 1 |
| AZ | $92.55 | 1 |
| CA | $98.10–$119.38 | 29 |
| CO | $97.50 | 1 |
| CT | $100.62 | 1 |
| DC | $106.61 | 1 |
| DE | $93.93 | 1 |
| FL | $95.13–$104.61 | 3 |
| GA | $90.30–$96.80 | 2 |
| GU | $99.75 | 1 |
| HI | $99.75 | 1 |
| IA | $87.49 | 1 |
| ID | $88.13 | 1 |
| IL | $93.23–$101.87 | 4 |
| IN | $88.55 | 1 |
| KS | $87.47 | 1 |
| KY | $88.76 | 1 |
| LA | $88.77–$92.52 | 2 |
| MA | $97.17–$105.81 | 2 |
| MD | $95.45–$106.61 | 3 |
| ME | $88.88–$92.55 | 2 |
| MI | $91.06–$96.51 | 2 |
| MN | $92.81 | 1 |
| MO | $87.68–$92.42 | 3 |
| MS | $86.45 | 1 |
| MT | $94.85 | 1 |
| NC | $89.63 | 1 |
| ND | $91.88 | 1 |
| NE | $87.81 | 1 |
| NH | $96.33 | 1 |
| NJ | $101.60–$105.82 | 2 |
| NM | $91.62 | 1 |
| NV | $94.07 | 1 |
| NY | $90.82–$111.29 | 5 |
| OH | $90.45 | 1 |
| OK | $88.27 | 1 |
| OR | $93.17–$99.87 | 2 |
| PA | $90.39–$98.62 | 2 |
| PR | $95.35 | 1 |
| RI | $96.74 | 1 |
| SC | $90.22 | 1 |
| SD | $91.53 | 1 |
| TN | $87.89 | 1 |
| TX | $89.90–$97.33 | 8 |
| UT | $91.28 | 1 |
| VA | $92.52–$106.61 | 2 |
| VI | $95.35 | 1 |
| VT | $91.87 | 1 |
| WA | $96.87–$107.48 | 2 |
| WI | $89.25 | 1 |
| WV | $90.32 | 1 |
| WY | $93.56 | 1 |
How the 54235 rate is calculated
Each of 54235’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 · 54235
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.16Practice expense 1.53Malpractice 0.15
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 54235
The CMS indicators that decide how 54235 is paid alongside other services.
CMS payment indicators · 54235
Penile injection
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is 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. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
54235 without 51 · national office
$94.86
Penile injection
54235-51 · Second procedure: 50%
$47.43
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%).
54235 compared with similar codes
Compare codes
54235 vs 54200 vs 54220 vs 54230 vs 54231: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 54200Plaque injection
- Use 54235 for pharmacologic injection into the corpora cavernosa. Code 54200 addresses injection treatment for Peyronie’s disease.
- 54220Corporal irrigation
- 54220 is irrigation of the corpora cavernosa for priapism; 54235 is pharmacologic injection for an erectile-function evaluation.
- 54230Cavernosography
- 54235 reports pharmacologic injection into the corpora cavernosa. Code 54230 is the injection procedure for cavernosography.
- 54231Cavernosometry
- 54231 reports dynamic cavernosometry, which measures penile pressure. 54235 reports the pharmacologic injection itself.
54235 billing questions
How does this differ from a Peyronie’s disease injection?
54235 describes pharmacologic injection into the corpora cavernosa, commonly to assess erectile response. Code 54200 is for injection treatment directed at Peyronie’s disease.
Is modifier 50 appropriate when both sides are injected?
No. The CMS bilateral adjustment does not apply to 54235, and modifier 50 is inappropriate.
What same-day care is included?
The 0-day global period includes same-day preoperative and postoperative care. The pharmacologic injection itself is the service reported.
How are other procedures handled in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction. The rule applies when procedures are performed in the same session.
Can an assistant or another surgeon be reported?
Medicare does not pay an assistant at surgery for 54235. 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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