CPT code 54401: Penile prosthesis2026 Medicare rate & RVUs in Illinois
Reports operative placement of a self-contained inflatable penile prosthesis, typically for erectile dysfunction when a patient chooses surgical treatment.
CMS doesn’t publish an office rate for 54401 in Illinois.
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 54401 covers
A urologist places an inflatable penile implant whose inflation mechanism is self-contained, rather than using a separate pump and reservoir. The procedure is generally performed in an operating room for erectile dysfunction when the patient and surgeon select an implant after considering other treatment options. The device type distinguishes this service from placement of a semi-rigid implant or a multi-component inflatable system.
Report 54401 for initial implantation of the self-contained inflatable device, and document the indication, device type, and operative placement. Medicare assigns major-surgery global status: the day-before preoperative visit and 90 days of related postoperative care are included. 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 inappropriate for this descriptor and anatomy. Medicare does not pay an assistant at surgery under the stated statutory restriction; 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.
Where 54401 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | Unavailable | $677.79 |
| East St. Louis | Unavailable | $643.25 |
| Rest Of Illinois | Unavailable | $621.88 |
| Suburban Chicago | Unavailable | $660.05 |
How the 54401 rate is calculated
Each of 54401’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 · 54401
RVUs × geographic indexes × conversion factor
Work10.18
10.18 RVUs× 1.000 GPCI
Practice expense7.00
7.00 RVUs× 1.000 GPCI
Malpractice1.31
1.31 RVUs× 1.000 GPCI
Adjusted RVUs
18.4900
Conversion factor
$33.4009
Medicare rate
$617.58
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 54401
54401 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 54401
Penile prosthesis
| 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) | 1 | Not paid (statutory restriction). |
| 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 · 54401
Penile prosthesis
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
54401 without 51 · national facility
$617.58
Penile prosthesis
54401-51 · Second procedure: 50%
$308.79
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%).
54401 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 54400Penile prosthesis
- Choose 54400 for a semi-rigid implant that does not inflate; 54401 is for an inflatable self-contained device.
- 54405Penile prosthesis
- Choose 54405 when the inflatable implant is multi-component. The self-contained inflation mechanism identifies 54401.
- 54416Penile prosthesis
- 54416 describes removal and replacement of an existing self-contained or semi-rigid prosthesis; 54401 is for implantation, not an exchange.
- 54415Prosthesis removal
- 54415 is for removing a prosthesis without replacement. Report 54401 for initial placement of the self-contained inflatable device.
54401 billing questions
How does 54401 differ from 54400?
54401 is for an inflatable, self-contained prosthesis. 54400 is for a non-inflatable, semi-rigid prosthesis.
When should 54405 be reported instead?
Use 54405 for an inflatable multi-component prosthesis, which has separate system components rather than a self-contained inflation mechanism.
Can modifier 50 be appended?
No. Modifier 50 is inappropriate for this descriptor and anatomy.
What postoperative care is included in the global period?
The day-before preoperative visit and 90 days of related postoperative care are included in the major-surgery global period.
How is 54401 handled when other procedures occur in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple procedure reduction. Medicare does not pay an assistant at surgery; co-surgeon payment requires supporting documentation.
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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