No office rate
54405 is for inserting a new multi-component inflatable prosthesis. Use 54408 when the existing device is repaired instead.
On this page
CMS RVU26D · Effective 2026-10-01
54408 Prosthesis repair Medicare reimbursement rates in Massachusetts
Repair of an implanted multi-component inflatable penile prosthesis is reported when the existing device is surgically repaired rather than removed and replaced. Compare 54408 office and facility rates across CMS payment localities in Massachusetts.
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 54408 in Massachusetts?
Massachusetts has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$724.46–$770.37
2 of 2 localities have a 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.
Urologic surgery
About 54408: Repair of multi-component penile prosthesis
Repair of an implanted multi-component inflatable penile prosthesis is reported when the existing device is surgically repaired rather than removed and replaced.
A urologist surgically repairs a previously implanted multi-component inflatable penile prosthesis when the device has a mechanical problem that can be addressed without removing and replacing it. The system includes implanted components such as cylinders and a pump, with a fluid reservoir in many designs. This is generally an operative service in a facility setting, rather than an office-based adjustment or evaluation of device function alone.
Report the repair when documentation identifies the existing multi-component device, the malfunction or damage, and the repair performed. Distinguish repair from removal alone, replacement, or insertion of a new prosthesis. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team-surgery payment is not permitted.
CMS billing rules for 54408
- 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 RVU13.56 · 63%
- Practice expense (office) RVU6.19 · 29%
- Malpractice RVU1.75 · 8%
237
Medicare services in 2024 · #4177 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.
54408 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
No office rate
54406 describes removal of a multi-component inflatable prosthesis. It is distinct from surgically repairing the existing device under 54408.
No office rate
54410 is used for removal and replacement of a penile prosthesis. Choose 54408 when the service repairs the existing device rather than replacing it.
Compare 54408 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.
2 of 2 payment localities
Metropolitan Boston →
Office / nonfacility
Unavailable
Facility
$770.37
Rest Of Massachusetts →
Office / nonfacility
Unavailable
Facility
$724.46
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54408 billing questions
How is repair different from insertion of a new prosthesis?
Report 54408 when the existing multi-component device is surgically repaired. Code 54405 describes insertion of a new multi-component prosthesis.
When would removal or replacement codes be more appropriate?
Use a removal code when the device is explanted without repair, or a removal-and-replacement code when the operative service replaces it. Documentation should show whether the existing device was repaired, removed, or replaced.
Are related postoperative visits included?
Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can modifier 50 be reported?
No. The descriptor and anatomy make modifier 50 inappropriate for this service.
How are assistant and co-surgeon services handled?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team-surgery payment is not permitted.
How is this code affected by other procedures in the same session?
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.
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.
6,29354401,,Insert self-contd prosthesis,A,,10.18,7.00,NA,7.00,,1.31,18.49,18.49,0,090,0.10,0.80,0.10,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,29454405,,Insert multi-comp penis pros,A,,14.16,5.84,NA,5.84,,1.82,21.82,21.82,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,29554406,,Remove muti-comp penis pros,A,,12.57,5.68,NA,5.68,,1.63,19.88,19.88,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,29654408,,Repair multi-comp penis pros,A,,13.56,6.19,NA,6.19,,1.75,21.50,21.50,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,29754410,,Remove/replace penis prosth,A,,14.80,6.71,NA,6.71,,1.91,23.42,23.42,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,29854411,,Remov/replc penis pros comp,A,,17.89,7.60,NA,7.60,,2.31,27.80,27.80,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,29954415,,Remove self-contd penis pros,A,,8.66,4.87,NA,4.87,,1.13,14.66,14.66,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00