No office rate
Use 54415 when the self-contained inflatable implant is removed without replacement. Report 54411 when removal is followed by placement of a replacement device.
On this page
CMS RVU26D · Effective 2026-10-01
54411 Prosthesis exchange Medicare reimbursement rates in Alabama
Reports removal and replacement of a self-contained inflatable penile implant when the existing device is exchanged for a new implant. Compare 54411 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 54411 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
$863.33
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.
Urologic surgery
About 54411: Self-contained inflatable penile prosthesis exchange
Reports removal and replacement of a self-contained inflatable penile implant when the existing device is exchanged for a new implant.
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.
CMS billing rules for 54411
- 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 RVU17.89 · 64%
- Practice expense (office) RVU7.60 · 27%
- Malpractice RVU2.31 · 8%
56
Medicare services in 2024 · #5284 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.
54411 compared with similar codes
Office rates for Alabama, from the same CMS release.
No office rate
Use 54416 for exchange of a multi-component inflatable system with separate components. This code is for a self-contained inflatable device.
No office rate
Use 54410 for exchange of a non-inflatable, semi-rigid implant. This code describes exchange of a self-contained inflatable implant.
No office rate
Use 54417 for a complicated exchange of a multi-component inflatable implant. This code describes exchange of a self-contained inflatable device.
Compare 54411 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
$863.33
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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 54411 in Alabama.
PPRRVU2026_Oct_nonQPP.csv
6,298
- Code
- 54411
- Physician work
- 17.89
- Practice expense
- 7.60
- Malpractice
- 2.31
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 17.89 | × 1.000 | 17.8900 |
| Practice expense | 7.60 | × 0.875 | 6.6500 |
| Malpractice | 2.31 | × 0.566 | 1.3075 |
| Total RVUs | 25.8475 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Alabama$863.33
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 17.89 | 1 |
| Practice expense | 7.6 | 0.875 |
| Malpractice | 2.31 | 0.566 |
(17.89 × 1 + 7.6 × 0.875 + 2.31 × 0.566) × $33.4009 = $863.33
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.
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 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.
6,29554406,,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
6,29954415,,Remove self-contd penis pros,A,,8.66,4.87,NA,4.87,,1.13,14.66,14.66,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,30054416,,Remv/repl penis contain pros,A,,11.78,6.33,NA,6.33,,1.50,19.61,19.61,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,30154417,,Remv/replc penis pros compl,A,,15.70,6.58,NA,6.58,,2.02,24.30,24.30,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,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