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Billing code 54406: Penile prosthesis removalMedicare rate & RVUs

Report removal of all components of a multicomponent inflatable penile prosthesis when the device is explanted and no replacement prosthesis is inserted.

CMS RVU26DEffective Oct 1, 2026109 payment localities615 Medicare services in 2024

Medicare pays $664.01 for 54406 nationally in a facility.

Medicare rate · 54406

Penile prosthesis removal

Swap in your local Medicare rate.

Work RVUs
12.57
Total RVUs
19.88
Global days
090

National rate · 2026

$664.01

Facility setting, before claim adjustments.

See every locality for 54406 → · 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
  1. Medicare rate
  2. What 54406 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 54406 covers

This operation removes the complete implanted system of a multicomponent inflatable penile prosthesis, including its cylinders, pump, and reservoir. Urologists typically perform it in a hospital or ambulatory surgery setting when the device must be explanted, such as for infection, erosion, malfunction, or another clinical reason. The defining distinction is that the prosthesis is removed without replacement during the same operative session; removal of only part of the system is not the service described by this code.

Report the code when the operative record supports removal of all components and confirms that no replacement prosthesis was inserted in that session. If all components are removed and replaced during the operation, consider the applicable removal-and-replacement code instead. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. 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. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is 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 54406 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

54406 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$616.67
Alaska*Unavailable$861.82
ArizonaUnavailable$650.29
ArkansasUnavailable$610.85
AtlantaUnavailable$679.25
AustinUnavailable$669.65
BakersfieldUnavailable$668.91
Baltimore/Surr. CntysUnavailable$697.48
BeaumontUnavailable$643.07
BrazoriaUnavailable$653.68

54406 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.

View every state and territory as a table
54406 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 54406 rate is calculated

Each of 54406’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 · 54406

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 12.57Practice expense 5.68Malpractice 1.63

19.8800 adjusted RVUs×$33.4009 conversion factor=$664.01

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 54406

54406 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 54406

Penile prosthesis removal

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.80/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 54406

Penile prosthesis removal

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

54406 without 51 · national facility

$664.01

Penile prosthesis removal

54406-51 · Second procedure: 50%

$332.01

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%).

When to use modifier 51

54406 compared with similar codes

Compare codes

54406 vs 54410 vs 54411 vs 54415 vs 54408: national Medicare rates

Swap in your local Medicare rate.

  • 54406
    Penile prosthesis removal · 12.57 wRVU
    —
  • 54410
    Prosthesis replacement · 14.8 wRVU
    —
  • 54411
    Prosthesis exchange · 17.89 wRVU
    —
  • 54415
    Prosthesis removal · 8.66 wRVU
    —
  • 54408
    Prosthesis repair · 13.56 wRVU
    —

How to choose

54410Prosthesis replacement
54406 describes complete removal without replacement. 54410 is the removal-and-replacement option when all components are exchanged in the same session.
54411Prosthesis exchange
Both involve removal and replacement of a multicomponent inflatable prosthesis; use 54411 when its additional criteria are documented, rather than for removal alone.
54415Prosthesis removal
54415 is for removal of a self-contained inflatable prosthesis. 54406 is for removal of all components of a multicomponent inflatable system.
54408Prosthesis repair
54408 describes repair of an inflatable prosthesis. Choose 54406 when the complete multicomponent device is removed without replacement, not when it is repaired.

Codes related to 54406

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

Codes related to 54406
CodeHow it relatesNational office range
Used instead
54410Prosthesis replacementRemoval and replacement of all components of a multicomponent inflatable prosthesis in the same session.No office rate
54411Prosthesis exchangeA removal-and-replacement option for a multicomponent inflatable prosthesis when its additional criteria are met.No office rate
54415Prosthesis removalRemoval code for a self-contained inflatable penile prosthesis rather than a multicomponent system.No office rate
54408Prosthesis repairRepair may be appropriate when the inflatable prosthesis is repaired rather than completely removed.No office rate
54405Penile prosthesisInsertion of a multicomponent inflatable prosthesis, rather than removal without replacement.No office rate

54406 billing questions

When should this code be used instead of 54410?

Use 54406 when all components of a multicomponent inflatable prosthesis are removed and no prosthesis is replaced in that session. When all components are removed and replaced during the same operation, consider 54410 or the applicable more complex removal-and-replacement code.

Does this code include removal of the pump and reservoir?

Yes. The service is removal of the complete multicomponent system, including its cylinders, pump, and reservoir. Document which components were removed.

Can modifier 50 be reported?

No. Medicare identifies bilateral adjustment as inappropriate for this code.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

How does Medicare handle another procedure performed in the same session?

Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50% when performed in the same session.

What documentation supports reporting this code?

The operative report should establish the multicomponent inflatable device, removal of all of its components, and that no replacement prosthesis was inserted during the session.

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
RVUs for 54406PPRRVU2026_Oct_nonQPP.csv, line 6,295 (RVU26D)

Open CMS sourceHow we calculate rates

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