No office rate
Use 54380 for epispadias repair distal to the bladder neck; 54385 is the related repair level involving the bladder neck.
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CMS RVU26D · Effective 2026-10-01
54380 Epispadias repair Medicare reimbursement rates in Michigan
Surgical repair of epispadias distal to the bladder neck, reported when the operation reconstructs the penile urethra and associated penile tissues. Compare 54380 office and facility rates across CMS payment localities in Michigan.
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 54380 in Michigan?
Michigan 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
$713.48–$756.94
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 54380: Epispadias repair distal to bladder neck
Surgical repair of epispadias distal to the bladder neck, reported when the operation reconstructs the penile urethra and associated penile tissues.
This operation repairs epispadias affecting the penis distal to the bladder neck. Epispadias is a congenital abnormality in which the urethral opening lies on the upper side of the penis; repair addresses the penile urethral and tissue defect. A pediatric urologist or urologist typically performs the reconstruction in an operating room, often for a child with this congenital condition.
Report the code when the operative work is an epispadias repair distal to the bladder neck. The operative report should identify the defect and describe the repair, including whether bladder-neck reconstruction was performed; involvement of the bladder neck points to a different level in the repair family. The service has a 90-day global period, including 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 reduction. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 54380
- 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 RVU13.83 · 64%
- Practice expense (office) RVU6.06 · 28%
- Malpractice RVU1.77 · 8%
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.
54380 compared with similar codes
Office rates for Michigan, from the same CMS release.
No office rate
54380 addresses penile epispadias repair distal to the bladder neck. The 54390 short descriptor identifies repair involving both the penis and bladder.
No office rate
54360 is penile plastic surgery for a different indication; 54380 is selected for repair of epispadias distal to the bladder neck.
Compare 54380 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
Detroit →
Office / nonfacility
Unavailable
Facility
$756.94
Rest Of Michigan →
Office / nonfacility
Unavailable
Facility
$713.48
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54380 billing questions
How is this distinguished from 54385?
This code is for epispadias repair distal to the bladder neck. Use 54385 when the repair involves the bladder neck.
What documentation supports this code?
The operative report should describe the epispadias defect, its location relative to the bladder neck, and the repair performed.
Can an assistant surgeon be paid?
Assistant-at-surgery payment may be available for this procedure. Co-surgeon payment requires supporting documentation.
Should modifier 50 be used?
Do not use modifier 50 to seek a bilateral adjustment for this penile repair.
How does the global period affect postoperative billing?
The 90-day global period includes the day-before preoperative visit and related postoperative care. The operative service and routine related care during that period are accounted for under the global package.
How are other procedures performed in the same session paid?
The highest-valued procedure is paid in full; other procedures performed in that session are subject to the standard multiple-procedure reduction.
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.
6,28654348,,Rpr hypspad comp dsj & urtp,A,,17.86,7.01,NA,7.01,,2.31,27.18,27.18,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,28754352,,Revj prior hypspad repair,A,,25.48,8.98,NA,8.98,,3.27,37.73,37.73,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,28854360,,Penis plastic surgery,A,,12.46,5.48,NA,5.48,,1.61,19.55,19.55,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,28954380,,Repair penis,A,,13.83,6.06,NA,6.06,,1.77,21.66,21.66,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,29054385,,Repair penis,A,,16.15,6.92,NA,6.92,,2.08,25.15,25.15,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,29154390,,Repair penis and bladder,A,,22.20,8.18,NA,8.18,,2.86,33.24,33.24,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,29254400,,Insert semi-rigid prosthesis,A,,8.94,4.43,NA,4.43,,1.15,14.52,14.52,0,090,0.10,0.80,0.10,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00