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Billing code 54420: Penile reconstructionMedicare rate & RVUs

Reconstructive penile surgery for injury-related structural damage is reported when the operation goes beyond direct repair of an acute tear.

CMS RVU26DEffective Oct 1, 2026109 payment localities20 Medicare services in 2024

Medicare pays $636.29 for 54420 nationally in a facility.

Medicare rate · 54420

Penile reconstruction

Swap in your local Medicare rate.

Work RVUs
12.08
Total RVUs
19.05
Global days
090

National rate · 2026

$636.29

Facility setting, before claim adjustments.

See every locality for 54420 → · 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 54420 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 54420 covers

This operation reconstructs the penis after injury-related damage or deformity. A urologist typically performs it in a hospital or other surgical setting, using an operative approach tailored to the injured anatomy and the reconstructive goal. It is distinct from placing or revising a penile prosthesis and from a limited repair of an acute corporal tear.

Report the code when the operative record supports a plastic reconstructive procedure for penile injury. Document the injury, affected structures, resulting defect or deformity, and the work performed; a diagnosis of trauma alone does not establish that this reconstruction was done. CMS 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. Modifier 50 is inappropriate. An assistant at surgery may be paid; 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 54420 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

54420 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$591.29
Alaska*Unavailable$826.72
ArizonaUnavailable$623.26
ArkansasUnavailable$585.77
AtlantaUnavailable$650.74
AustinUnavailable$641.75
BakersfieldUnavailable$641.25
Baltimore/Surr. CntysUnavailable$668.17
BeaumontUnavailable$616.31
BrazoriaUnavailable$626.57

54420 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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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
54420 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 54420 rate is calculated

Each of 54420’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 · 54420

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 12.08Practice expense 5.43Malpractice 1.54

19.0500 adjusted RVUs×$33.4009 conversion factor=$636.29

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

Payment rules and modifiers for 54420

54420 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 54420

Penile reconstruction

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)0Not permitted.
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 · 54420

Penile reconstruction

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

54420 without 51 · national facility

$636.29

Penile reconstruction

54420-51 · Second procedure: 50%

$318.15

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

54420 compared with similar codes

Compare codes

54420 vs 54437 vs 54440 vs 54430 vs 54435: national Medicare rates

Swap in your local Medicare rate.

  • 54420
    Penile reconstruction · 12.08 wRVU
    —
  • 54437
    Corporal tear repair · 11.21 wRVU
    —
  • 54440
    · 0 wRVU
    —
  • 54430
    Penile reconstruction · 10.78 wRVU
    —
  • 54435
    Penile repair · 6.64 wRVU
    —

How to choose

54437Corporal tear repair
54437 describes repair of a corporeal tear. Use 54420 when the operation is reconstructive surgery for injury-related penile damage, not simply repair of the tear.
54440Repair of penis
54440 is a penile repair code. Choose 54420 when the operative service is plastic reconstruction for injury rather than the repair service documented for 54440.
54430Penile reconstruction
Both are penile plastic-operation codes, but the indication and work documented determine the correct code. Do not select 54420 unless the reconstruction is for injury.
54435Penile repair
This is another nearby penile revision code. Compare the specific indication and operative service rather than treating the codes as interchangeable.

Codes related to 54420

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

Codes related to 54420
CodeHow it relatesNational office range
Same family
54430Penile reconstructionA nearby penile plastic-operation code; distinguish it by the indication and procedure documented.No office rate
54435Penile repairAnother penile revision code; select according to the specific reconstructive service performed.No office rate
Used instead
54437Corporal tear repairUsed for repair of a corporeal tear rather than broader injury-related penile reconstruction.No office rate
54440Repair of penisA penile repair code to consider when the documented service is repair rather than plastic reconstruction.No office rate

54420 billing questions

How is this distinguished from repair of a corporal tear?

Use this code for reconstructive plastic surgery addressing injury-related penile damage. A procedure focused on repairing an acute corporeal tear is represented by 54437.

What documentation supports reporting this code?

Record the injury and its resulting anatomic damage or deformity, the reconstructive objective, and the operative work performed. The note should make clear why the service was reconstruction rather than a limited tear repair.

Can modifier 50 be reported?

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

How does the 90-day global period affect postoperative billing?

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

What happens when another procedure is performed in the same session?

CMS applies the standard multiple-procedure reduction: the highest-valued procedure is paid in full, and other procedures are paid at 50%.

May an assistant or co-surgeon be reported?

An assistant at surgery may be paid. Co-surgeons and team surgery are not permitted under the CMS rules for this code.

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 54420PPRRVU2026_Oct_nonQPP.csv, line 6,302 (RVU26D)

Open CMS sourceHow we calculate rates

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