No office rate
Both address penile curvature from Peyronie disease. Choose 54430 when graft reconstruction is performed; 54420 describes the repair without grafting.
On this page
CMS RVU26D · Effective 2026-10-01
54430 Penile reconstruction Medicare reimbursement rates in Delaware
Reports operative correction of penile curvature from Peyronie disease when plaque release or removal is combined with graft reconstruction. Compare 54430 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 54430 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
No supported rate
Facility setting
$576.58
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 surgery
About 54430: Peyronie curvature repair with graft
Reports operative correction of penile curvature from Peyronie disease when plaque release or removal is combined with graft reconstruction.
A urologist uses this operation to correct penile curvature caused by Peyronie disease when straightening requires graft material after releasing or removing the scarred plaque. The procedure is performed in an operating room, commonly for a patient whose curvature interferes with sexual function. The operative report should identify the deformity and plaque treatment, explain why graft reconstruction was performed, and describe the graft used and the repair achieved.
Choose this code when the Peyronie repair includes grafting; the related procedure without a graft is 54420. Medicare assigns a 90-day global period, which includes the day-before preoperative visit and related postoperative care during that period. 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% multiple procedure reduction. The code is priced as bilateral, so modifier 50 does not increase payment. An assistant at surgery may be paid; co-surgeons and team surgery are not permitted.
CMS billing rules for 54430
- 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
- The code is already priced as bilateral; modifier 50 does not increase payment.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU10.78 · 62%
- Practice expense (office) RVU5.26 · 30%
- Malpractice RVU1.37 · 8%
45
Medicare services in 2024 · #5423 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.
54430 compared with similar codes
Office rates for Delaware, from the same CMS release.
No office rate
This code is used for straightening chordee, not graft reconstruction for Peyronie-related curvature.
No office rate
This reports placement of a multicomponent penile prosthesis for erectile dysfunction, not graft repair of Peyronie-related curvature.
Compare 54430 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
Unavailable
Facility
$576.58
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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 54430 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
6,303
- Code
- 54430
- Physician work
- 10.78
- Practice expense
- 5.26
- Malpractice
- 1.37
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 10.78 | × 1.005 | 10.8339 |
| Practice expense | 5.26 | × 0.988 | 5.1969 |
| Malpractice | 1.37 | × 0.899 | 1.2316 |
| Total RVUs | 17.2624 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Delaware$576.58
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 10.78 | 1.005 |
| Practice expense | 5.26 | 0.988 |
| Malpractice | 1.37 | 0.899 |
(10.78 × 1.005 + 5.26 × 0.988 + 1.37 × 0.899) × $33.4009 = $576.58
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.
54430 billing questions
How do I choose between 54430 and 54420?
Use 54430 when the Peyronie repair includes graft reconstruction. Use 54420 for the corresponding repair without a graft.
What documentation supports reporting 54430?
The operative report should establish Peyronie-related curvature, describe plaque release or removal, and document graft placement as part of the reconstruction.
Can 54430 be reported with penile prosthesis insertion?
It may be performed in the same session as prosthesis insertion when erectile dysfunction also requires an implant. Document the distinct work performed for each service; the multiple procedure reduction may apply.
Should modifier 50 be appended?
The code is already priced as bilateral, and modifier 50 does not increase payment.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. CMS does not permit co-surgeons or team surgery for this code.
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.
6,30054416,,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
6,30254420,,Revision of penis,A,,12.08,5.43,NA,5.43,,1.54,19.05,19.05,0,090,0.10,0.80,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,30354430,,Revision of penis,A,,10.78,5.26,NA,5.26,,1.37,17.41,17.41,0,090,0.10,0.80,0.10,2,2,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,30454435,,Revision of penis,A,,6.64,3.99,NA,3.99,,0.86,11.49,11.49,0,090,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,30554437,,Repair corporeal tear,A,,11.21,5.90,NA,5.90,,1.44,18.55,18.55,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,30654440,,Repair of penis,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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