No office rate
54415 is removal without replacement. Choose 54416 when a new semi-rigid prosthesis is placed during the same operative session.
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CMS RVU26D · Effective 2026-10-01
54416 Penile prosthesis Medicare reimbursement rates in Georgia
Urologists report this service when they remove and replace a non-inflatable, semi-rigid penile prosthesis during the same operative session. Compare 54416 office and facility rates across CMS payment localities in Georgia.
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 54416 in Georgia?
Georgia has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$641.78–$669.63
2 of 2 localities have a supported rate.
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 54416: Semi-rigid penile prosthesis replacement
Urologists report this service when they remove and replace a non-inflatable, semi-rigid penile prosthesis during the same operative session.
A urologist removes an existing semi-rigid penile implant and places a replacement during the same operation. These devices use bendable rods rather than an inflatable pump system and are used to treat erectile dysfunction. The procedure is generally performed in a hospital or ambulatory surgery setting when the implanted device needs replacement, such as because of malfunction or another clinical concern.
Report this code for the same-session removal and replacement of a non-inflatable device; the operative report should identify the prosthesis type and document both removal and replacement. Extensive urethral or bladder repair points to the more complex related code, 54417. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 54416
- 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 RVU11.78 · 60%
- Practice expense (office) RVU6.33 · 32%
- Malpractice RVU1.50 · 8%
120
Medicare services in 2024 · #4738 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.
54416 compared with similar codes
Office rates for Georgia, from the same CMS release.
No office rate
54417 identifies the more complex semi-rigid replacement involving extensive urethral or bladder repair; 54416 describes replacement without that added complexity.
No office rate
54410 is for removal and replacement of a multi-component inflatable prosthesis. This code is for a non-inflatable, semi-rigid device.
Compare 54416 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.
2 of 2 payment localities
Atlanta →
Office / nonfacility
Unavailable
Facility
$669.63
Rest Of Georgia →
Office / nonfacility
Unavailable
Facility
$641.78
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54416 billing questions
How is this different from code 54415?
Use 54416 when the semi-rigid prosthesis is removed and replaced in the same operative session. Code 54415 describes removal without replacement.
Should removal and insertion be billed as separate procedures?
No. This code describes the same-session removal and replacement of the semi-rigid device; document both parts of the operation.
When should code 54417 be considered?
Use 54417 for the more complex semi-rigid prosthesis replacement involving extensive urethral or bladder repair.
Can modifier 50 be used?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this service.
What global-period services are included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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.
6,29754410,,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
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