$154.80
54000 is for a preputial incision without extensive adhesion release. Report 54001 when extensive lysis of adhesions is part of the procedure.
On this page
CMS RVU26D · Effective 2026-10-01
54001 Prepuce incision Medicare reimbursement rates in Nebraska
Reports a dorsal or lateral incision of the foreskin with extensive release of adhesions, typically to relieve clinically significant preputial tightness. Compare 54001 office and facility rates across CMS payment localities in Nebraska.
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 54001 in Nebraska?
Nebraska 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
$188.44
1 of 1 localities have a supported rate.
Payment area: Nebraska
One mapped payment locality.
Facility setting
$120.31
1 of 1 localities have a supported rate.
Payment area: Nebraska
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 54001: Preputial incision with extensive adhesion release
Reports a dorsal or lateral incision of the foreskin with extensive release of adhesions, typically to relieve clinically significant preputial tightness.
A urologist or other qualified physician makes a dorsal or lateral incision in the foreskin and releases extensive adhesions between the foreskin and glans. This may be performed when tight or adherent foreskin prevents adequate retraction or causes related symptoms. The procedure preserves the foreskin; it is not a circumcision. It is performed in an office or facility setting, depending on the patient and the planned care.
Choose this code when the operative work includes extensive adhesion release, rather than an incision alone. The note should identify the indication, incision site, and extent of adhesions released. Medicare assigns a 10-day global period, which includes related postoperative visits 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 50% multiple-procedure reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
CMS billing rules for 54001
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days 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
- 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 RVU2.18 · 36%
- Practice expense (office) RVU3.64 · 60%
- Malpractice RVU0.27 · 4%
1.5K
Medicare services in 2024 · #2677 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.
54001 compared with similar codes
Office rates for Nebraska, from the same CMS release.
No office rate
54161 describes circumcision by surgical excision for a patient outside the newborn age group. Choose it when foreskin removal is performed, rather than an incision with adhesion release.
Compare 54001 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
Nebraska →
Office / nonfacility
$188.44
Facility
$120.31
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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 54001 in Nebraska.
PPRRVU2026_Oct_nonQPP.csv
6,236
- Code
- 54001
- Physician work
- 2.18
- Practice expense
- 3.64
- Malpractice
- 0.27
GPCI2026.csv
72
- Locality
- Nebraska
- Physician work
- 1.000
- Practice expense
- 0.923
- Malpractice
- 0.378
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.18 | × 1.000 | 2.1800 |
| Practice expense | 3.64 | × 0.923 | 3.3597 |
| Malpractice | 0.27 | × 0.378 | 0.1021 |
| Total RVUs | 5.6418 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Nebraska$188.44
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.18 | 1 |
| Practice expense | 3.64 | 0.923 |
| Malpractice | 0.27 | 0.378 |
(2.18 × 1 + 3.64 × 0.923 + 0.27 × 0.378) × $33.4009 = $188.44
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.18 | 1 |
| Practice expense | 1.43 | 0.923 |
| Malpractice | 0.27 | 0.378 |
(2.18 × 1 + 1.43 × 0.923 + 0.27 × 0.378) × $33.4009 = $120.31
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.
54001 billing questions
How does this differ from 54000?
Use 54001 when the procedure includes extensive release of adhesions. Code 54000 describes a preputial incision without that extensive adhesion work.
Is this a circumcision?
No. The procedure releases the foreskin by incision and extensive adhesion lysis while preserving it. If the planned procedure removes the foreskin, consider the applicable circumcision code instead.
What documentation supports 54001?
Document the clinical indication, incision location, and the extensive adhesions released. The note should make clear why the work goes beyond an incision alone.
Are postoperative visits included?
Related postoperative visits during the 10-day global period are included in the procedure's global package.
Can modifier 50 or an assistant surgeon be reported?
Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for this service.
How are other procedures in the same session handled?
The highest-valued procedure is paid in full, and other procedures performed in the same session are subject to the standard 50% 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.
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