$105.14
Choose 54250 for overnight recording of penile tumescence and rigidity during sleep. Code 54240 describes penile plethysmography, a separate testing method.
On this page
CMS RVU26D · Effective 2026-10-01
54250 Nocturnal erection testing Medicare reimbursement rates in Indiana
Reports overnight measurement of penile tumescence and rigidity to evaluate erectile dysfunction and help distinguish sleep-related erectile responses. Compare 54250 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 54250 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
$116.74
1 of 1 localities have a supported rate.
Payment area: Indiana
One mapped payment locality.
Facility setting
No 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 diagnostic testing
About 54250: Nocturnal penile tumescence and rigidity testing
Reports overnight measurement of penile tumescence and rigidity to evaluate erectile dysfunction and help distinguish sleep-related erectile responses.
This test monitors changes in penile size and rigidity during sleep, typically overnight, as part of an evaluation for erectile dysfunction. A urology practice may arrange the study, with staff applying or setting up monitoring equipment and a qualified clinician interpreting the recorded results. The findings can help assess whether normal sleep-related erections occur; they are considered alongside the patient’s history and other evaluation findings.
Report the study when nocturnal tumescence and rigidity are measured and interpreted, rather than for penile plethysmography or an invasive vascular study. Documentation should identify the erectile dysfunction evaluation, describe the study performed, and include the recorded findings and interpretation. Modifier 26 identifies the professional interpretation, TC identifies the technical service, and an unmodified claim represents the global service. The 0-day global includes same-day preoperative and postoperative care. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 54250
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Professional and technical components
- Diagnostic test with a professional component (modifier 26, interpretation) and a technical component (modifier TC, equipment and staff); billing without a modifier is the global service.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU2.16 · 58%
- Practice expense (office) RVU1.33 · 36%
- Malpractice RVU0.21 · 6%
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.
54250 compared with similar codes
Office rates for Indiana, from the same CMS release.
$103.18
Code 54230 is for cavernosography, an invasive imaging assessment of penile vascular anatomy; it does not report nocturnal monitoring.
$139.26
Code 54231 reports dynamic cavernosometry, an invasive vascular assessment. Code 54250 measures tumescence and rigidity during sleep.
Compare 54250 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
$116.74
Facility
Unavailable
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 54250 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
6,269
- Code
- 54250
- Physician work
- 2.16
- Practice expense
- 1.33
- Malpractice
- 0.21
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.16 | × 1.000 | 2.1600 |
| Practice expense | 1.33 | × 0.927 | 1.2329 |
| Malpractice | 0.21 | × 0.486 | 0.1021 |
| Total RVUs | 3.4950 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Indiana$116.74
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.16 | 1 |
| Practice expense | 1.33 | 0.927 |
| Malpractice | 0.21 | 0.486 |
(2.16 × 1 + 1.33 × 0.927 + 0.21 × 0.486) × $33.4009 = $116.74
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.
54250 billing questions
How does this differ from penile plethysmography, code 54240?
Code 54250 reports measurement of nocturnal penile tumescence and rigidity during sleep. Code 54240 is penile plethysmography, a different testing method.
Can the professional and technical portions be billed separately?
Yes. Modifier 26 identifies the professional interpretation, and modifier TC identifies the equipment and staff portion. Billing without either modifier represents the global service.
Should modifier 50 be appended?
No. The test is not billed as a bilateral service, and modifier 50 is inappropriate.
What documentation supports reporting this test?
Document the erectile dysfunction evaluation, the nocturnal monitoring performed, the recorded tumescence and rigidity findings, and the clinician’s interpretation.
How does this test differ from cavernosometry or cavernosography?
This code reports sleep-related erection monitoring. Codes 54231 and 54230 describe invasive vascular assessment methods rather than an overnight study.
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.
6,26654240,,Penile plethysmography,A,,1.28,1.91,,1.91,NA,0.20,3.39,3.39,1,000,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,26754240,26,Penile plethysmography,A,,1.28,0.53,,0.53,,0.18,1.99,1.99,1,000,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,26854240,TC,Penile plethysmography,A,,0.00,1.38,,1.38,NA,0.02,1.40,1.40,1,000,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,02,0,99,0.00,0.00,0.00
6,26954250,,Nctrnl pen tmscn&/rgdity tst,A,,2.16,1.33,,1.33,NA,0.21,3.70,3.70,1,000,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,27054250,26,Nctrnl pen tmscn&/rgdity tst,A,,2.16,0.90,,0.90,,0.20,3.26,3.26,1,000,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,27154250,TC,Nctrnl pen tmscn&/rgdity tst,A,,0.00,0.43,,0.43,NA,0.01,0.44,0.44,1,000,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,01,0,99,0.00,0.00,0.00
6,27254300,,Revision of penis,A,,10.92,5.27,NA,5.27,,1.43,17.62,17.62,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,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