$267.35
54100 describes a penile biopsy that is not deep; 54105 is the sibling code for deep penile tissue sampling.
On this page
CMS RVU26D · Effective 2026-10-01
54100 Biopsy Medicare reimbursement rates in Kentucky
A clinician samples penile tissue to evaluate a suspicious lesion, ulcer, or plaque when diagnosis requires histologic examination. Compare 54100 office and facility rates across CMS payment localities in Kentucky.
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 54100 in Kentucky?
Kentucky 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
$187.57
1 of 1 localities have a supported rate.
Payment area: Kentucky
One mapped payment locality.
Facility setting
$99.38
1 of 1 localities have a supported rate.
Payment area: Kentucky
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 procedure
About 54100: Penile lesion biopsy
A clinician samples penile tissue to evaluate a suspicious lesion, ulcer, or plaque when diagnosis requires histologic examination.
A urologist or other qualified clinician takes a tissue sample from the penis to investigate a finding such as a persistent ulcer, atypical plaque, or suspected neoplasm. The procedure is commonly performed in an office or outpatient setting, often with local anesthesia. The tissue is sent for microscopic examination to help establish a diagnosis; this code represents the biopsy, not therapeutic removal of a lesion.
Report this code for a penile biopsy that is not the deeper sampling represented by 54105. The record should identify the sampled site, the lesion or clinical concern, and the biopsy performed. Same-day preoperative and postoperative care is included in this 0-day global period. If other procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% multiple-procedure reduction. Do not append modifier 50; CMS treats bilateral adjustment as inappropriate for this code. Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery reporting are not permitted.
CMS billing rules for 54100
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU1.85 · 30%
- Practice expense (office) RVU4.03 · 66%
- Malpractice RVU0.20 · 3%
3.1K
Medicare services in 2024 · #2151 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.
54100 compared with similar codes
Office rates for Kentucky, from the same CMS release.
No office rate
54100 obtains tissue for diagnosis. Use the applicable lesion-treatment code when the service treats the penile lesion rather than sampling it.
No office rate
54100 is a diagnostic tissue-sampling service. 54120 describes partial removal of the penis, a substantially more extensive therapeutic operation.
Compare 54100 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
Kentucky →
Office / nonfacility
$187.57
Facility
$99.38
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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 54100 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
6,244
- Code
- 54100
- Physician work
- 1.85
- Practice expense
- 4.03
- Malpractice
- 0.20
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.85 | × 1.000 | 1.8500 |
| Practice expense | 4.03 | × 0.889 | 3.5827 |
| Malpractice | 0.20 | × 0.915 | 0.1830 |
| Total RVUs | 5.6157 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Kentucky$187.57
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.85 | 1 |
| Practice expense | 4.03 | 0.889 |
| Malpractice | 0.2 | 0.915 |
(1.85 × 1 + 4.03 × 0.889 + 0.2 × 0.915) × $33.4009 = $187.57
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.85 | 1 |
| Practice expense | 1.06 | 0.889 |
| Malpractice | 0.2 | 0.915 |
(1.85 × 1 + 1.06 × 0.889 + 0.2 × 0.915) × $33.4009 = $99.38
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.
54100 billing questions
How is 54100 distinguished from 54105?
Use 54100 for a penile biopsy that is not deep. Use 54105 when the documented service is a deep penile biopsy.
Can the lesion be removed instead of biopsied?
This code describes tissue sampling for diagnosis, not treatment of the lesion. When the service treats a penile lesion rather than obtaining a diagnostic sample, consider the applicable lesion-treatment code, such as 54110.
Is the pathology examination included?
The biopsy code represents obtaining the tissue. A laboratory or pathologist may separately report the histopathology service, such as 88305, when performed.
Should modifier 50 be reported for multiple penile biopsy sites?
No. CMS identifies bilateral adjustment as inappropriate for this code, so do not append modifier 50.
How are same-session procedures paid?
When other procedures are performed in the same session, the highest-valued procedure is paid in full and the remaining procedures are subject to the standard 50% multiple-procedure reduction.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for 54100. Co-surgeons and team surgery are not permitted.
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.
6,24154057,,Laser surg penis lesion(s),A,,1.26,2.89,,1.31,,0.16,4.31,2.73,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,24254060,,Excision of penis lesion(s),A,,1.93,3.85,,1.50,,0.24,6.02,3.67,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,24354065,,Destruction penis lesion(s),A,,2.41,4.01,,1.85,,0.25,6.67,4.51,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,24454100,,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
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
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631