No office rate
Use 54205 when the plaque is surgically exposed for injection; 54200 is for plaque injection without that exposure.
On this page
CMS RVU26D · Effective 2026-10-01
54200 Plaque injection Medicare reimbursement rates in Delaware
A urologist injects medication into a penile plaque to treat Peyronie's disease, rather than injecting the corpora cavernosa for diagnostic testing. Compare 54200 office and facility rates across CMS payment localities in Delaware.
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 54200 in Delaware?
Delaware 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
$119.99
1 of 1 localities have a supported rate.
Payment area: Delaware
One mapped payment locality.
Facility setting
$82.70
1 of 1 localities have a supported rate.
Payment area: Delaware
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 procedure
About 54200: Peyronie's plaque injection
A urologist injects medication into a penile plaque to treat Peyronie's disease, rather than injecting the corpora cavernosa for diagnostic testing.
A urologist uses this code for a therapeutic injection directed into the fibrous penile plaque associated with Peyronie's disease. The service is commonly performed in an office or other outpatient setting for a patient with penile curvature or deformity from plaque. The injection targets the plaque; it is distinct from medication injected into the corpora cavernosa to assess erectile response. When a separately reportable drug is supplied, its billing is distinct from the injection procedure.
Report the service when the record supports treatment of Peyronie's plaque and documents the injection performed. The code has a 10-day global period, so related postoperative visits during that period are included. If 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 inappropriate for this code. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
CMS billing rules for 54200
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU1.08 · 30%
- Practice expense (office) RVU2.41 · 66%
- Malpractice RVU0.14 · 4%
8.8K
Medicare services in 2024 · #1541 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.
54200 compared with similar codes
Office rates for Delaware, from the same CMS release.
$93.93
54235 is an injection of a pharmacologic agent into the corpora cavernosa, commonly for erectile-response assessment; 54200 treats a Peyronie's plaque.
$109.47
54230 describes injection for cavernosography, a diagnostic imaging study of the corpora cavernosa, rather than therapeutic injection into a Peyronie's plaque.
Compare 54200 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
Delaware →
Office / nonfacility
$119.99
Facility
$82.70
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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 54200 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
6,260
- Code
- 54200
- Physician work
- 1.08
- Practice expense
- 2.41
- Malpractice
- 0.14
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.08 | × 1.005 | 1.0854 |
| Practice expense | 2.41 | × 0.988 | 2.3811 |
| Malpractice | 0.14 | × 0.899 | 0.1259 |
| Total RVUs | 3.5923 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Delaware$119.99
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.08 | 1.005 |
| Practice expense | 2.41 | 0.988 |
| Malpractice | 0.14 | 0.899 |
(1.08 × 1.005 + 2.41 × 0.988 + 0.14 × 0.899) × $33.4009 = $119.99
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.08 | 1.005 |
| Practice expense | 1.28 | 0.988 |
| Malpractice | 0.14 | 0.899 |
(1.08 × 1.005 + 1.28 × 0.988 + 0.14 × 0.899) × $33.4009 = $82.70
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.
54200 billing questions
How does 54200 differ from 54205?
54200 describes injection treatment without surgical exposure of the plaque. 54205 is the related code for injection performed with surgical exposure of the plaque.
Can the medication be billed separately?
The injection procedure and a separately reportable drug are distinct items. Report a drug code only when the drug was supplied and the applicable drug billing requirements are met.
Is modifier 50 appropriate for multiple plaques or both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; do not use modifier 50.
What documentation supports 54200?
Document Peyronie's disease, the plaque treated, the therapeutic injection performed, and the clinical context supporting plaque-directed treatment.
Are related follow-up visits included?
Yes. Related postoperative visits during the 10-day global period are included in the procedure payment.
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.
6,25754162,,Lysis penil circumic lesion,A,,3.24,4.25,,1.86,,0.42,7.91,5.52,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,25854163,,Repair of circumcision,A,,3.24,2.54,NA,2.54,,0.42,6.20,6.20,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,25954164,,Frenulotomy of penis,A,,2.75,2.44,NA,2.44,,0.36,5.55,5.55,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,26054200,,Injection px peyronie ds,A,,1.08,2.41,,1.28,,0.14,3.63,2.50,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,26154205,,Njx px peyronie ds exps plaq,A,,8.75,4.74,NA,4.74,,1.13,14.62,14.62,0,090,0.10,0.80,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,26254220,,Irrg crpra cavrnosa priapism,A,,2.36,4.76,,1.09,,0.43,7.55,3.88,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,26354230,,Njx corpora cavernosograpy,A,,1.31,1.83,,0.71,,0.17,3.31,2.19,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503