No office rate
54406 describes complete removal without replacement. 54410 is the removal-and-replacement option when all components are exchanged in the same session.
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CMS RVU26D · Effective 2026-10-01
54406 Penile prosthesis removal Medicare reimbursement rates in Alabama
Report removal of all components of a multicomponent inflatable penile prosthesis when the device is explanted and no replacement prosthesis is inserted. Compare 54406 office and facility rates across CMS payment localities in Alabama.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 54406 in Alabama?
Alabama has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$616.67
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Urology surgery
About 54406: Removal of multicomponent penile prosthesis
Report removal of all components of a multicomponent inflatable penile prosthesis when the device is explanted and no replacement prosthesis is inserted.
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.
CMS billing rules for 54406
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU12.57 · 63%
- Practice expense (office) RVU5.68 · 29%
- Malpractice RVU1.63 · 8%
615
Medicare services in 2024 · #3371 by national volume
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.
54406 compared with similar codes
Office rates for Alabama, from the same CMS release.
No office rate
Both involve removal and replacement of a multicomponent inflatable prosthesis; use 54411 when its additional criteria are documented, rather than for removal alone.
No office rate
54415 is for removal of a self-contained inflatable prosthesis. 54406 is for removal of all components of a multicomponent inflatable system.
No office rate
54408 describes repair of an inflatable prosthesis. Choose 54406 when the complete multicomponent device is removed without replacement, not when it is repaired.
Compare 54406 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Alabama →
Office / nonfacility
Unavailable
Facility
$616.67
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 54406 in Alabama.
PPRRVU2026_Oct_nonQPP.csv
6,295
- Code
- 54406
- Physician work
- 12.57
- Practice expense
- 5.68
- Malpractice
- 1.63
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 12.57 | × 1.000 | 12.5700 |
| Practice expense | 5.68 | × 0.875 | 4.9700 |
| Malpractice | 1.63 | × 0.566 | 0.9226 |
| Total RVUs | 18.4626 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Alabama$616.67
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 12.57 | 1 |
| Practice expense | 5.68 | 0.875 |
| Malpractice | 1.63 | 0.566 |
(12.57 × 1 + 5.68 × 0.875 + 1.63 × 0.566) × $33.4009 = $616.67
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
6,29254400,,Insert semi-rigid prosthesis,A,,8.94,4.43,NA,4.43,,1.15,14.52,14.52,0,090,0.10,0.80,0.10,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,29354401,,Insert self-contd prosthesis,A,,10.18,7.00,NA,7.00,,1.31,18.49,18.49,0,090,0.10,0.80,0.10,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,29454405,,Insert multi-comp penis pros,A,,14.16,5.84,NA,5.84,,1.82,21.82,21.82,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,29554406,,Remove muti-comp penis pros,A,,12.57,5.68,NA,5.68,,1.63,19.88,19.88,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,29654408,,Repair multi-comp penis pros,A,,13.56,6.19,NA,6.19,,1.75,21.50,21.50,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,29754410,,Remove/replace penis prosth,A,,14.80,6.71,NA,6.71,,1.91,23.42,23.42,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,29854411,,Remov/replc penis pros comp,A,,17.89,7.60,NA,7.60,,2.31,27.80,27.80,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1ADDENDUM E. FINAL CY 2026 GEOGRAPHIC PRACTICE COST INDICES (GPCIs) BY STATE AND MEDICARE LOCALITY,,,,,,
2,,,,,,
3Medicare Administrative Contractor (MAC),State,Locality Number,Locality Name,2026 PW GPCI (with 1.0 Floor)***,2026 PE GPCI,2026 MP GPCI
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515