No office rate
Choose 54401 when the inserted device is an inflatable, self-contained prosthesis; use 54400 for a semi-rigid, non-inflatable device.
On this page
CMS RVU26D · Effective 2026-10-01
54400 Penile prosthesis Medicare reimbursement rates in Nebraska
Reports surgical placement of a semi-rigid penile prosthesis for erectile dysfunction when a non-inflatable implant is selected. Compare 54400 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 54400 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
No supported rate
Facility setting
$449.70
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 surgery
About 54400: Semi-rigid penile prosthesis insertion
Reports surgical placement of a semi-rigid penile prosthesis for erectile dysfunction when a non-inflatable implant is selected.
A urologist places bendable, non-inflatable rods within the penile erectile bodies to provide penile rigidity. This operation is used for erectile dysfunction when a semi-rigid device is selected, including situations in which a patient prefers a simpler implant that does not require an inflation pump. It is generally performed in a surgical setting, with the operative record identifying the device type and documenting placement.
Select this code for initial insertion of a semi-rigid prosthesis, not an inflatable device or an exchange of an existing implant. Documentation should support the indication, the implant type, and the procedure performed. The CMS global period is 90 days, including the day-before preoperative visit and related postoperative care. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple procedure reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 54400
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU8.94 · 62%
- Practice expense (office) RVU4.43 · 31%
- Malpractice RVU1.15 · 8%
275
Medicare services in 2024 · #4060 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.
54400 compared with similar codes
Office rates for Nebraska, from the same CMS release.
No office rate
Code 54405 describes insertion of a multi-component prosthesis. Code 54400 is for a semi-rigid implant.
No office rate
Code 54410 is for removal and replacement of all components of a non-inflatable prosthesis. Code 54400 is for insertion, not exchange, of a semi-rigid implant.
Compare 54400 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
Unavailable
Facility
$449.70
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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 54400 in Nebraska.
PPRRVU2026_Oct_nonQPP.csv
6,292
- Code
- 54400
- Physician work
- 8.94
- Practice expense
- 4.43
- Malpractice
- 1.15
GPCI2026.csv
72
- Locality
- Nebraska
- Physician work
- 1.000
- Practice expense
- 0.923
- Malpractice
- 0.378
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 8.94 | × 1.000 | 8.9400 |
| Practice expense | 4.43 | × 0.923 | 4.0889 |
| Malpractice | 1.15 | × 0.378 | 0.4347 |
| Total RVUs | 13.4636 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Nebraska$449.70
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 8.94 | 1 |
| Practice expense | 4.43 | 0.923 |
| Malpractice | 1.15 | 0.378 |
(8.94 × 1 + 4.43 × 0.923 + 1.15 × 0.378) × $33.4009 = $449.70
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.
54400 billing questions
How is this code distinguished from 54401?
This code is for a semi-rigid, non-inflatable implant. Code 54401 is for an inflatable prosthesis with a self-contained design.
When should 54405 be considered instead?
Use 54405 for insertion of a multi-component penile prosthesis. This code describes placement of a semi-rigid implant.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeons are paid only when supporting documentation is provided.
How does a same-session second procedure affect payment?
The highest-valued procedure is paid in full, and other procedures 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.
6,28954380,,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
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
6905302,MO,01,METROPOLITAN ST. LOUIS,1.000,0.952,1.002
7005302,MO,99,REST OF MISSOURI,1.000,0.862,0.974
7103202,MT,01,MONTANA**,1.000,1.000,0.998
7205402,NE,00,NEBRASKA,1.000,0.923,0.378
7301312,NV,00,NEVADA**,1.000,1.001,0.833
7414312,NH,40,NEW HAMPSHIRE,1.000,1.041,0.875
7512402,NJ,01,NORTHERN NJ,1.063,1.160,1.068