No office rate
Use 54110 for simple penile plaque excision without graft reconstruction; 54111 includes graft-based reconstruction.
On this page
CMS RVU26D · Effective 2026-10-01
54111 Penile lesion surgery Medicare reimbursement rates in Indiana
Reports surgical removal of a penile plaque with graft reconstruction, commonly for Peyronie disease when operative correction requires grafting. Compare 54111 office and facility rates across CMS payment localities in Indiana.
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 54111 in Indiana?
Indiana has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$675.63
1 of 1 localities have a supported rate.
Payment area: Indiana
One mapped payment locality.
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 54111: Penile plaque excision with graft
Reports surgical removal of a penile plaque with graft reconstruction, commonly for Peyronie disease when operative correction requires grafting.
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.
CMS billing rules for 54111
- 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 RVU14.06 · 65%
- Practice expense (office) RVU5.71 · 26%
- Malpractice RVU1.80 · 8%
26
Medicare services in 2024 · #5763 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.
54111 compared with similar codes
Office rates for Indiana, from the same CMS release.
No office rate
Both are graft-related penile-lesion procedures. Use the full descriptor and operative details to determine which service was performed.
$189.82
54100 is a penile biopsy, a diagnostic tissue-sampling service; 54111 is operative plaque or lesion treatment with graft reconstruction.
No office rate
54120 describes partial removal of the penis, rather than plaque excision with graft reconstruction.
Compare 54111 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.
1 of 1 payment localities
Indiana →
Office / nonfacility
Unavailable
Facility
$675.63
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 54111 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
6,247
- Code
- 54111
- Physician work
- 14.06
- Practice expense
- 5.71
- Malpractice
- 1.80
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 14.06 | × 1.000 | 14.0600 |
| Practice expense | 5.71 | × 0.927 | 5.2932 |
| Malpractice | 1.80 | × 0.486 | 0.8748 |
| Total RVUs | 20.2280 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Indiana$675.63
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 14.06 | 1 |
| Practice expense | 5.71 | 0.927 |
| Malpractice | 1.8 | 0.486 |
(14.06 × 1 + 5.71 × 0.927 + 1.8 × 0.486) × $33.4009 = $675.63
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 CPT 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 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.
6,24454100,,Biopsy of penis,A,,1.85,4.03,,1.06,,0.20,6.08,3.11,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,24554105,,Biopsy of penis,A,,3.45,4.67,,1.96,,0.44,8.56,5.85,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,24654110,,Treatment of penis lesion,A,,10.65,5.01,NA,5.01,,1.36,17.02,17.02,0,090,0.10,0.80,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,24754111,,Treat penis lesion graft,A,,14.06,5.71,NA,5.71,,1.80,21.57,21.57,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,24854112,,Treat penis lesion graft,A,,16.56,6.56,NA,6.56,,2.13,25.25,25.25,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,24954115,,Treatment of penis lesion,A,,6.78,6.59,,4.20,,0.88,14.25,11.86,0,090,0.10,0.80,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,25054120,,Partial removal of penis,A,,10.73,5.14,NA,5.14,,1.39,17.26,17.26,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915