Billing code 54430: Penile reconstructionMedicare rate & RVUs in Illinois
Reports operative correction of penile curvature from Peyronie disease when plaque release or removal is combined with graft reconstruction.
CMS doesn’t publish an office rate for 54430 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 54430 covers
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.
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 54430 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 | $644.17 |
| East St. Louis | Unavailable | $613.85 |
| Rest Of Illinois | Unavailable | $591.99 |
| Suburban Chicago | Unavailable | $624.10 |
How the 54430 rate is calculated
Each of 54430’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 · 54430
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 10.78Practice expense 5.26Malpractice 1.37
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 54430
54430 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 54430
Penile reconstruction
| 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) | 2 | Already bilateral by definition: paid once at 100%. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 0 | Not permitted. |
| 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 · 54430
Penile reconstruction
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
54430 without 51 · national facility
$581.51
Penile reconstruction
54430-51 · Second procedure: 50%
$290.76
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%).
54430 compared with similar codes
Compare codes
54430 vs 54420 vs 54360 vs 54405: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 54420Penile reconstruction
- Both address penile curvature from Peyronie disease. Choose 54430 when graft reconstruction is performed; 54420 describes the repair without grafting.
- 54360Penile plastic surgery
- This code is used for straightening chordee, not graft reconstruction for Peyronie-related curvature.
- 54405Penile prosthesis
- This reports placement of a multicomponent penile prosthesis for erectile dysfunction, not graft repair of Peyronie-related curvature.
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 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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