No office rate
54437 describes repair of a corporeal tear. Use 54420 when the operation is reconstructive surgery for injury-related penile damage, not simply repair of the tear.
On this page
CMS RVU26D · Effective 2026-10-01
54420 Penile reconstruction Medicare reimbursement rates in Missouri
Reconstructive penile surgery for injury-related structural damage is reported when the operation goes beyond direct repair of an acute tear. Compare 54420 office and facility rates across CMS payment localities in Missouri.
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 54420 in Missouri?
Missouri has 3 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 3 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$609.92–$627.68
3 of 3 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.
Where 54420 pays more and less in Missouri
Urology surgery
About 54420: Penile reconstruction for injury
Reconstructive penile surgery for injury-related structural damage is reported when the operation goes beyond direct repair of an acute tear.
This operation reconstructs the penis after injury-related damage or deformity. A urologist typically performs it in a hospital or other surgical setting, using an operative approach tailored to the injured anatomy and the reconstructive goal. It is distinct from placing or revising a penile prosthesis and from a limited repair of an acute corporal tear.
Report the code when the operative record supports a plastic reconstructive procedure for penile injury. Document the injury, affected structures, resulting defect or deformity, and the work performed; a diagnosis of trauma alone does not establish that this reconstruction was done. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeons and team surgery are not permitted.
CMS billing rules for 54420
- 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 not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU12.08 · 63%
- Practice expense (office) RVU5.43 · 29%
- Malpractice RVU1.54 · 8%
20
Medicare services in 2024 · #5927 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.
54420 compared with similar codes
Office rates for Missouri, from the same CMS release.
54440
No office rateRepair of penis
54440 is a penile repair code. Choose 54420 when the operative service is plastic reconstruction for injury rather than the repair service documented for 54440.
No office rate
Both are penile plastic-operation codes, but the indication and work documented determine the correct code. Do not select 54420 unless the reconstruction is for injury.
No office rate
This is another nearby penile revision code. Compare the specific indication and operative service rather than treating the codes as interchangeable.
Compare 54420 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.
3 of 3 payment localities
Metropolitan Kansas City →
Office / nonfacility
Unavailable
Facility
$624.04
Metropolitan St. Louis →
Office / nonfacility
Unavailable
Facility
$627.68
Rest Of Missouri →
Office / nonfacility
Unavailable
Facility
$609.92
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54420 billing questions
How is this distinguished from repair of a corporal tear?
Use this code for reconstructive plastic surgery addressing injury-related penile damage. A procedure focused on repairing an acute corporeal tear is represented by 54437.
What documentation supports reporting this code?
Record the injury and its resulting anatomic damage or deformity, the reconstructive objective, and the operative work performed. The note should make clear why the service was reconstruction rather than a limited tear repair.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
What happens when another procedure is performed in the same session?
CMS applies the standard multiple-procedure reduction: the highest-valued procedure is paid in full, and other procedures are paid at 50%.
May an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons and team surgery are not permitted under the CMS rules for this code.
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.
6,29954415,,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
6,30054416,,Remv/repl penis contain pros,A,,11.78,6.33,NA,6.33,,1.50,19.61,19.61,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,30154417,,Remv/replc penis pros compl,A,,15.70,6.58,NA,6.58,,2.02,24.30,24.30,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,30254420,,Revision of penis,A,,12.08,5.43,NA,5.43,,1.54,19.05,19.05,0,090,0.10,0.80,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,30354430,,Revision of penis,A,,10.78,5.26,NA,5.26,,1.37,17.41,17.41,0,090,0.10,0.80,0.10,2,2,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,30454435,,Revision of penis,A,,6.64,3.99,NA,3.99,,0.86,11.49,11.49,0,090,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,30554437,,Repair corporeal tear,A,,11.21,5.90,NA,5.90,,1.44,18.55,18.55,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00