No office rate
54380 describes simple penile repair; 54385 is for a complicated repair. The operative report should substantiate the distinction.
On this page
CMS RVU26D · Effective 2026-10-01
54385 Penile repair Medicare reimbursement rates in New Jersey
Reports surgical repair of the penis when the operative work is complicated rather than a simple repair or a separately defined penile procedure. Compare 54385 office and facility rates across CMS payment localities in New Jersey.
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 54385 in New Jersey?
New Jersey 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
$889.61–$915.72
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.
Urology surgery
About 54385: Complicated penile repair
Reports surgical repair of the penis when the operative work is complicated rather than a simple repair or a separately defined penile procedure.
A urologist uses this code for a complicated surgical repair of penile tissue. The procedure is performed in an operating-room setting, such as a hospital or ambulatory surgery center, when the documented repair is more involved than a simple penile repair. The operative report should describe the condition treated, the affected structures, the repair performed, and the factors that support reporting the complicated rather than simple repair code.
Report one unit for the completed repair. The day-before preoperative visit and 90 days of related postoperative care are included in the surgical global period. When other procedures are performed in the same session, the highest-valued procedure is paid in full and additional procedures are subject to the standard multiple-procedure reduction. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 54385
- 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 RVU16.15 · 64%
- Practice expense (office) RVU6.92 · 28%
- Malpractice RVU2.08 · 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.
54385 compared with similar codes
Office rates for New Jersey, from the same CMS release.
54440
No office rateRepair of penis
54440 is the fracture-specific penile suture procedure. Choose it when the operation is repair of a penile fracture rather than a different complicated penile repair.
No office rate
54390 includes repair of both the penis and bladder. 54385 describes penile repair without that combined-site distinction.
Compare 54385 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
Northern Nj →
Office / nonfacility
Unavailable
Facility
$915.72
Rest Of New Jersey →
Office / nonfacility
Unavailable
Facility
$889.61
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
54385 billing questions
How does this differ from 54380?
54385 is the complicated penile repair; 54380 is the simple repair. The operative documentation should support the level reported.
Is a penile fracture repair reported with 54385?
The code specifically describing suture of the penis for fracture is 54440. Use the code that matches the procedure actually performed and documented.
Are related postoperative visits separately reported?
Related postoperative care during the 90-day global period is included, as is the day-before preoperative visit.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What happens when another procedure is performed in the same session?
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.
6,28754352,,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
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