Billing code 54450: Foreskin stretchingMedicare rate & RVUs
Manual stretching of the foreskin to address phimosis is reported when a clinician treats a restricted preputial opening without performing circumcision.
Medicare pays $71.81 for 54450 nationally in the office and $50.44 in a hospital or facility. Local office rates run $65.10–$89.74.
Medicare rate · 54450
Foreskin stretching
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- Work RVUs
- 1.09
- Total RVUs
- 2.15
- Global days
- 000
National rate · 2026
$71.81
Office setting, before claim adjustments.
See every locality for 54450 → · 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
What 54450 covers
A urologist or other qualified clinician manually stretches a narrowed foreskin when phimosis limits its retraction. The treatment is intended to improve the preputial opening without removing the foreskin, as circumcision does. It may be performed in an office or facility, depending on the patient’s needs and the care setting.
Report 54450 when the stretching is performed as treatment, and document the phimosis and the intervention. The code has a 0-day global period, so same-day preoperative and postoperative care is included. If multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others 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, and co-surgeon and team-surgery billing 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 54450 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
$65.10 to $89.74
109 of 109 payment localities
54450 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.
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$65.10
$89.74
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 | $89.74 | 1 |
| AL | $65.84 | 1 |
| AR | $65.10 | 1 |
| AZ | $70.15 | 1 |
| CA | $73.02–$86.93 | 29 |
| CO | $73.10 | 1 |
| CT | $75.93 | 1 |
| DC | $79.75 | 1 |
| DE | $71.12 | 1 |
| FL | $72.99–$80.72 | 3 |
| GA | $69.49–$73.41 | 2 |
| GU | $73.87 | 1 |
| HI | $73.87 | 1 |
| IA | $66.21 | 1 |
| ID | $66.74 | 1 |
| IL | $71.99–$78.71 | 4 |
| IN | $67.02 | 1 |
| KS | $66.41 | 1 |
| KY | $68.01 | 1 |
| LA | $68.11–$70.70 | 2 |
| MA | $72.99–$78.65 | 2 |
| MD | $72.13–$79.75 | 3 |
| ME | $67.49–$69.69 | 2 |
| MI | $69.81–$74.19 | 2 |
| MN | $69.17 | 1 |
| MO | $67.49–$70.36 | 3 |
| MS | $66.28 | 1 |
| MT | $71.80 | 1 |
| NC | $67.97 | 1 |
| ND | $68.84 | 1 |
| NE | $66.36 | 1 |
| NH | $72.43 | 1 |
| NJ | $76.55–$79.31 | 2 |
| NM | $70.30 | 1 |
| NV | $71.01 | 1 |
| NY | $68.80–$84.18 | 5 |
| OH | $69.21 | 1 |
| OK | $67.44 | 1 |
| OR | $70.20–$74.49 | 2 |
| PA | $69.04–$74.68 | 2 |
| PR | $72.07 | 1 |
| RI | $72.97 | 1 |
| SC | $68.75 | 1 |
| SD | $68.49 | 1 |
| TN | $66.73 | 1 |
| TX | $68.72–$73.77 | 8 |
| UT | $69.48 | 1 |
| VA | $69.82–$79.75 | 2 |
| VI | $72.07 | 1 |
| VT | $69.03 | 1 |
| WA | $72.70–$79.62 | 2 |
| WI | $67.07 | 1 |
| WV | $69.99 | 1 |
| WY | $70.51 | 1 |
How the 54450 rate is calculated
Each of 54450’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 · 54450
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.09Practice expense 0.91Malpractice 0.15
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 54450
The CMS indicators that decide how 54450 is paid alongside other services.
CMS payment indicators · 54450
Foreskin stretching
| 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
54450 without 51 · national office
$71.81
Foreskin stretching
54450-51 · Second procedure: 50%
$35.91
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%).
54450 compared with similar codes
Compare codes
54450 vs 54150 vs 54161 vs 54162: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 54150Circumcision
- 54450 treats phimosis by manually stretching the foreskin. Code 54150 is for circumcision performed with a clamp or other device.
- 54161Circumcision
- Use 54450 for manual stretching without foreskin removal. Code 54161 describes surgical circumcision for patients older than 28 days.
- 54162Penile adhesion lysis
- Code 54162 addresses penile adhesions after circumcision. Code 54450 is for manually stretching a narrowed foreskin in the treatment of phimosis.
54450 billing questions
When should 54450 be reported instead of a circumcision code?
Report 54450 when the clinician manually stretches the narrowed foreskin to treat phimosis without removing it. Use a circumcision code when the procedure excises the foreskin or uses a circumcision device.
Is 54450 appropriate for post-circumcision adhesions?
Not when the service is lysis or excision of penile adhesions after circumcision; that service is distinguished by 54162. Document whether the problem treated is a narrowed foreskin or adhesions.
Can modifier 50 be appended to 54450?
No. CMS identifies bilateral adjustment as inappropriate for this service because of its descriptor or anatomy.
How does a same-session procedure affect payment?
When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction.
Can an assistant, co-surgeon, or surgical team be billed for 54450?
Medicare does not pay an assistant at surgery for this service. 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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