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Billing code 54430: Penile reconstructionMedicare rate & RVUs

Reports operative correction of penile curvature from Peyronie disease when plaque release or removal is combined with graft reconstruction.

CMS RVU26DEffective Oct 1, 2026109 payment localities45 Medicare services in 2024

Medicare pays $581.51 for 54430 nationally in a facility.

Medicare rate · 54430

Penile reconstruction

Work RVUs
10.78
Total RVUs
17.41
Global days
090

National rate · 2026

$581.51

Facility setting, before claim adjustments.

See every locality for 54430 →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 54430 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 54430 covers

A urologist uses this operation to correct penile curvature caused by Peyronie disease when straightening requires graft material after releasing or removing the scarred plaque. The procedure is performed in an operating room, commonly for a patient whose curvature interferes with sexual function. The operative report should identify the deformity and plaque treatment, explain why graft reconstruction was performed, and describe the graft used and the repair achieved.

Choose this code when the Peyronie repair includes grafting; the related procedure without a graft is 54420. Medicare assigns a 90-day global period, which includes the day-before preoperative visit and related postoperative care during that period. 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% multiple procedure reduction. The code is priced as bilateral, so modifier 50 does not increase payment. 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 54430 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

54430 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$539.69
Alaska*Unavailable$752.41
ArizonaUnavailable$569.47
ArkansasUnavailable$534.54
AtlantaUnavailable$594.60
AustinUnavailable$587.20
BakersfieldUnavailable$587.33
Baltimore/Surr. CntysUnavailable$610.94
BeaumontUnavailable$562.45
BrazoriaUnavailable$572.74

54430 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
54430 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 54430 rate is calculated

Each of 54430’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 · 54430

RVUs × geographic indexes × conversion factor

Work10.78

10.78 RVUs× 1.000 GPCI

Practice expense5.26

5.26 RVUs× 1.000 GPCI

Malpractice1.37

1.37 RVUs× 1.000 GPCI

Adjusted RVUs

17.4100

Conversion factor

$33.4009

Medicare rate

$581.51

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 54430

54430 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 54430

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)2Already bilateral by definition: paid once at 100%.
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 · 54430

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned 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

54430 without 51 · national facility

$581.51

Penile reconstruction

54430-51 · Second procedure: 50%

$290.76

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

54430 compared with similar codes

Compare codes · National

4 codes, side by side

  • 54430

    Penile reconstruction10.78 wRVU

    Not priced

  • 54420

    Penile reconstruction12.08 wRVU

    Not priced

  • 54360

    Penile plastic surgery12.46 wRVU

    Not priced

  • 54405

    Penile prosthesis14.16 wRVU

    Not priced

How to choose

54420Penile reconstruction
Both address penile curvature from Peyronie disease. Choose 54430 when graft reconstruction is performed; 54420 describes the repair without grafting.
54360Penile plastic surgery
This code is used for straightening chordee, not graft reconstruction for Peyronie-related curvature.
54405Penile prosthesis
This reports placement of a multicomponent penile prosthesis for erectile dysfunction, not graft repair of Peyronie-related curvature.

Codes related to 54430

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

Codes related to 54430
CodeHow it relatesNational office range
Same family
54420Penile reconstructionPeyronie repair without graft; distinguishes the graft-based reconstruction reported with 54430.No office rate
Used instead
54360Penile plastic surgeryPenile straightening for chordee, rather than curvature from Peyronie disease requiring graft reconstruction.No office rate
Often billed with
54405Penile prosthesisMay accompany Peyronie graft repair when erectile dysfunction also requires multicomponent prosthesis placement.No office rate

54430 billing questions

How do I choose between 54430 and 54420?

Use 54430 when the Peyronie repair includes graft reconstruction. Use 54420 for the corresponding repair without a graft.

What documentation supports reporting 54430?

The operative report should establish Peyronie-related curvature, describe plaque release or removal, and document graft placement as part of the reconstruction.

Can 54430 be reported with penile prosthesis insertion?

It may be performed in the same session as prosthesis insertion when erectile dysfunction also requires an implant. Document the distinct work performed for each service; the multiple procedure reduction may apply.

Should modifier 50 be appended?

The code is already priced as bilateral, and modifier 50 does not increase payment.

What postoperative care is included?

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

Can an assistant or co-surgeon be reported?

An assistant at surgery may be paid. CMS does not permit co-surgeons or team surgery 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 54430PPRRVU2026_Oct_nonQPP.csv, line 6,303 (RVU26D)

Open CMS sourceHow we calculate rates

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