Billing code 54111: Penile lesion surgeryMedicare rate & RVUs in Florida
Reports surgical removal of a penile plaque with graft reconstruction, commonly for Peyronie disease when operative correction requires grafting.
CMS doesn’t publish an office rate for 54111 in Florida.
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 54111 covers
A urologist uses this service to remove or release a penile plaque and reconstruct the resulting defect with a graft. A typical setting is operative treatment of Peyronie disease when plaque-related curvature or deformity calls for grafting; the operative report should identify the plaque, the work performed, and the graft reconstruction. This is a more involved service than a diagnostic penile biopsy or simple plaque excision without grafting.
Select the code from the documented operative work, including the lesion or plaque addressed and the graft reconstruction performed. The service has 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 one session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple procedure reduction. Do not use modifier 50 for a bilateral adjustment. Assistant-at-surgery payment may be made; co-surgeons require 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.
Where 54111 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | Unavailable | $771.52 |
| Miami | Unavailable | $820.20 |
| Rest Of Florida | Unavailable | $742.31 |
How the 54111 rate is calculated
Each of 54111’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 · 54111
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 14.06Practice expense 5.71Malpractice 1.80
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 54111
54111 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 54111
Penile lesion surgery
| 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 · 54111
Penile lesion surgery
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
54111 without 51 · national facility
$720.46
Penile lesion surgery
54111-51 · Second procedure: 50%
$360.23
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%).
54111 compared with similar codes
Compare codes
54111 vs 54110 vs 54112 vs 54100 vs 54120: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 54110Penile lesion treatment
- Use 54110 for simple penile plaque excision without graft reconstruction; 54111 includes graft-based reconstruction.
- 54112Penile plaque surgery
- Both are graft-related penile-lesion procedures. Use the full descriptor and operative details to determine which service was performed.
- 54100Biopsy
- 54100 is a penile biopsy, a diagnostic tissue-sampling service; 54111 is operative plaque or lesion treatment with graft reconstruction.
- 54120Penile surgery
- 54120 describes partial removal of the penis, rather than plaque excision with graft reconstruction.
54111 billing questions
How does 54111 differ from 54110?
54111 is for plaque or lesion surgery that includes graft reconstruction. 54110 describes simple penile plaque excision without grafting.
When should 54112 be considered instead?
54112 is a neighboring graft-related penile-lesion service. Compare its full billing code descriptor with the documented operative work before choosing between the two.
Can a penile biopsy be reported with 54111?
54100 and 54105 describe penile biopsy services, not graft reconstruction. Report a biopsy only when it is a distinct, documented service rather than part of the operative work.
How are other procedures in the same session paid?
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.
Which surgical-assistance rules affect this code?
Assistant-at-surgery payment may be made. Co-surgeons require supporting documentation, and team surgery is not permitted.
Should modifier 50 be used for bilateral treatment?
No. The descriptor or anatomy makes modifier 50 inappropriate for a bilateral adjustment.
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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