Billing code 54125: PenectomyMedicare rate & RVUs in Delaware
Reports surgery removing the entire penis, typically for extensive penile cancer when an organ-preserving operation cannot adequately treat the disease.
CMS doesn’t publish an office rate for 54125 in Delaware.
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 9 sections
What 54125 covers
This code describes an operation removing the entire penis, rather than only a portion. Urologists typically perform it in an operating room for extensive penile cancer that cannot be managed with organ-preserving treatment. Urinary drainage may require a perineal urethrostomy; the operative report should make the extent of penile removal clear and describe any associated procedures.
Report the code when the operative documentation supports complete removal, not partial removal or treatment of a penile lesion. A major-surgery global period includes the day-before preoperative visit and 90 days of related postoperative care. 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% reduction. Modifier 50 is not appropriate for removal of this single organ. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is 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.
54125 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | Unavailable | $740.45 |
How the 54125 rate is calculated
Each of 54125’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 · 54125
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 14.20Practice expense 6.21Malpractice 1.96
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 54125
54125 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 54125
Penectomy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are 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) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 54125
Penectomy
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
54125 without 51 · national facility
$747.18
Penectomy
54125-51 · Second procedure: 50%
$373.59
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%).
54125 compared with similar codes
Compare codes
54125 vs 54120 vs 54130 vs 54135 vs 54100: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 54120Penile surgery
- 54120 is for partial removal; 54125 requires removal of the entire penis.
- 54130Radical penectomy
- 54130 describes radical penile resection with bilateral inguinal lymphadenectomy, not complete penile removal alone.
- 54135Penectomy
- 54135 describes radical penile resection with additional lymphadenectomy; select based on the documented extent of nodal surgery.
- 54100Biopsy
- 54100 is a penile biopsy for tissue diagnosis, not definitive removal of the entire penis.
54125 billing questions
When should 54125 be chosen over 54120?
Use 54125 when the entire penis is removed. Use 54120 when the operation removes only part of it.
Does 54125 include inguinal lymph node removal?
The code describes complete penile removal. When the operation also includes radical resection with inguinal lymphadenectomy, compare the applicable 54130 or 54135 code and document the nodal procedure.
Should modifier 50 be reported?
No. Modifier 50 is not appropriate for removal of the penis as a single organ.
What documentation supports 54125?
The operative report should establish that the entire penis was removed and describe the indication, such as extensive penile cancer, and the extent of the operation.
How does the global period affect postoperative billing?
The major-surgery global period includes the day-before preoperative visit and 90 days of related postoperative care.
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 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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