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Billing code 54411: Prosthesis exchangeMedicare rate & RVUs

Reports removal and replacement of a self-contained inflatable penile implant when the existing device is exchanged for a new implant.

CMS RVU26DEffective Oct 1, 2026109 payment localities56 Medicare services in 2024

Medicare pays $928.55 for 54411 nationally in a facility.

Medicare rate · 54411

Prosthesis exchange

Swap in your local Medicare rate.

Work RVUs
17.89
Total RVUs
27.80
Global days
090

National rate · 2026

$928.55

Facility setting, before claim adjustments.

See every locality for 54411 → · 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 54411 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 54411 covers

A urologist performs this operation when an existing self-contained inflatable penile prosthesis is removed and replaced. This device type differs from a multi-component system with separate cylinders, pump, and reservoir. The work is generally performed in an operating room for a failed or otherwise unsuitable implant; the operative record should identify the device type and describe removal and placement of its components.

Report the exchange only when the existing self-contained device is removed and a replacement is placed. Documentation should support the device configuration, reason for exchange, and operative work. 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% reduction. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted. Modifier 50 is inappropriate for this procedure.

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 54411 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

54411 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$863.33
Alaska*Unavailable$1,209.17
ArizonaUnavailable$909.57
ArkansasUnavailable$855.33
AtlantaUnavailable$949.91
AustinUnavailable$935.67
BakersfieldUnavailable$934.10
Baltimore/Surr. CntysUnavailable$974.92
BeaumontUnavailable$900.22
BrazoriaUnavailable$914.07

54411 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
54411 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 54411 rate is calculated

Each of 54411’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 · 54411

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 17.89Practice expense 7.60Malpractice 2.31

27.8000 adjusted RVUs×$33.4009 conversion factor=$928.55

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

Payment rules and modifiers for 54411

54411 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 54411

Prosthesis exchange

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 · 54411

Prosthesis exchange

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

54411 without 51 · national facility

$928.55

Prosthesis exchange

54411-51 · Second procedure: 50%

$464.28

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

54411 compared with similar codes

Compare codes

54411 vs 54415 vs 54416 vs 54410 vs 54417: national Medicare rates

Swap in your local Medicare rate.

  • 54411
    Prosthesis exchange · 17.89 wRVU
    —
  • 54415
    Prosthesis removal · 8.66 wRVU
    —
  • 54416
    Penile prosthesis · 11.78 wRVU
    —
  • 54410
    Prosthesis replacement · 14.8 wRVU
    —
  • 54417
    Penile prosthesis · 15.7 wRVU
    —

How to choose

54415Prosthesis removal
Use 54415 when the self-contained inflatable implant is removed without replacement. Report 54411 when removal is followed by placement of a replacement device.
54416Penile prosthesis
Use 54416 for exchange of a multi-component inflatable system with separate components. This code is for a self-contained inflatable device.
54410Prosthesis replacement
Use 54410 for exchange of a non-inflatable, semi-rigid implant. This code describes exchange of a self-contained inflatable implant.
54417Penile prosthesis
Use 54417 for a complicated exchange of a multi-component inflatable implant. This code describes exchange of a self-contained inflatable device.

Codes related to 54411

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

Codes related to 54411
CodeHow it relatesNational office range
Same family
54401Penile prosthesisInsertion-only code for a self-contained inflatable penile prosthesis.No office rate
54415Prosthesis removalRemoval-only code for a self-contained inflatable penile prosthesis.No office rate
Used instead
54410Prosthesis replacementExchange code for a non-inflatable, semi-rigid penile prosthesis.No office rate
54416Penile prosthesisExchange code for a multi-component inflatable penile prosthesis.No office rate
54417Penile prosthesisComplicated exchange code for a multi-component inflatable penile prosthesis.No office rate

54411 billing questions

How is this different from 54416?

This code is for exchanging a self-contained inflatable implant. Code 54416 describes exchange of a multi-component inflatable system.

Can removal or insertion alone be reported with this exchange?

This code covers removal and replacement together. Removal without replacement or insertion without removal is a different service and should be evaluated under the code for that work.

What documentation supports reporting the exchange?

Document the existing implant’s configuration, why it was exchanged, removal of the existing device, and placement of the replacement.

Should modifier 50 be appended?

No. Modifier 50 is inappropriate for this procedure; it is not reported as a bilateral service.

How does the 90-day global period affect follow-up?

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

When can an assistant or co-surgeon be reported?

An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is 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
RVUs for 54411PPRRVU2026_Oct_nonQPP.csv, line 6,298 (RVU26D)

Open CMS sourceHow we calculate rates

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