Billing code 54405: Penile prosthesisMedicare rate & RVUs in Illinois
Reports surgical placement of a multi-component inflatable penile prosthesis, including its cylinders, scrotal pump, and fluid reservoir, for erectile dysfunction.
CMS doesn’t publish an office rate for 54405 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 54405 covers
A urologist surgically places an inflatable device for a patient with erectile dysfunction who has chosen prosthetic treatment. The system uses cylinders within the corpora cavernosa, a pump in the scrotum, and a fluid reservoir typically placed in the abdomen or pelvis. The procedure is generally performed in an operating room, including a hospital or ambulatory surgery setting. The pump transfers fluid to the cylinders to produce an erection; the patient operates the device after healing.
Report this code for insertion of the multi-component system, rather than a semi-rigid implant or a self-contained inflatable device. The operative report should support the device type and placement of its components. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted. Modifier 50 is inappropriate for this code.
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 54405 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 | $811.82 |
| East St. Louis | Unavailable | $774.84 |
| Rest Of Illinois | Unavailable | $746.06 |
| Suburban Chicago | Unavailable | $784.31 |
How the 54405 rate is calculated
Each of 54405’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 · 54405
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 14.16Practice expense 5.84Malpractice 1.82
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 54405
54405 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 54405
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) | 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 · 54405
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
54405 without 51 · national facility
$728.81
Penile prosthesis
54405-51 · Second procedure: 50%
$364.41
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%).
54405 compared with similar codes
Compare codes
54405 vs 54400 vs 54401 vs 54410: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 54400Penile prosthesis
- Choose 54400 for insertion of a semi-rigid implant. Choose 54405 for a system with separate inflatable cylinders, pump, and reservoir.
- 54401Penile prosthesis
- 54401 describes insertion of a self-contained inflatable device; 54405 describes placement of the separate components of a multi-component system.
- 54410Prosthesis replacement
- 54410 applies when an existing multi-component inflatable prosthesis is removed and replaced in the same operative session. 54405 is for insertion, not exchange of an existing system.
54405 billing questions
How does this differ from 54400?
54405 is for a multi-component inflatable system with separate cylinders, pump, and reservoir. 54400 describes insertion of a semi-rigid prosthesis.
How does this differ from 54401?
54401 is for a self-contained inflatable prosthesis. Use 54405 when the implanted system has separate cylinders, pump, and reservoir.
Are the pump, cylinders, and reservoir separately reported?
They are the components of the multi-component prosthesis insertion represented by 54405, not separate insertion services under this code.
Should modifier 50 be appended?
No. CMS identifies bilateral adjustment as inappropriate for this code because of its descriptor or anatomy.
How are assistant and co-surgeon services handled?
An assistant at surgery may be paid. Co-surgeons are paid only with supporting documentation, and team surgery is not permitted.
What postoperative care is 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 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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