$216.81
54160 is an initial circumcision procedure for a neonate. Use 54163 when the service surgically corrects a prior circumcision.
On this page
CMS RVU26D · Effective 2026-10-01
54163 Circumcision repair Medicare reimbursement rates in Ohio
Surgical revision of a prior circumcision to correct residual foreskin or an unsatisfactory result when operative repair, rather than initial circumcision, is performed. Compare 54163 office and facility rates across CMS payment localities in Ohio.
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 54163 in Ohio?
Ohio 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
$199.82
1 of 1 localities have a supported rate.
Payment area: Ohio
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.
Urologic surgery
About 54163: Surgical repair of prior circumcision
Surgical revision of a prior circumcision to correct residual foreskin or an unsatisfactory result when operative repair, rather than initial circumcision, is performed.
This service revises anatomy after an earlier circumcision, such as correcting residual foreskin or an irregular result that requires surgical repair. A urologist or pediatric urologist typically performs the procedure in an operating room or ambulatory surgery setting. It is distinct from performing a circumcision for the first time and from treating an isolated adhesion or frenular problem.
Report 54163 when the operative service repairs a prior circumcision, not merely because circumcision appears in the history. The record should identify the prior procedure, the specific defect or residual tissue, and the repair performed. The 10-day global period 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 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 54163
- 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 RVU3.24 · 52%
- Practice expense (office) RVU2.54 · 41%
- Malpractice RVU0.42 · 7%
157
Medicare services in 2024 · #4531 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.
54163 compared with similar codes
Office rates for Ohio, from the same CMS release.
No office rate
54161 is an initial circumcision procedure for a patient 28 days or older. It does not describe revision of a prior circumcision.
$251.96
54162 describes lysis of penile adhesions. Choose 54163 when the operative target is repair of the circumcision result rather than isolated adhesion release.
No office rate
54164 describes a penile frenulotomy. Choose 54163 for repair of a circumcision defect, not an isolated frenular procedure.
Compare 54163 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
Ohio →
Office / nonfacility
Unavailable
Facility
$199.82
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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 54163 in Ohio.
PPRRVU2026_Oct_nonQPP.csv
6,258
- Code
- 54163
- Physician work
- 3.24
- Practice expense
- 2.54
- Malpractice
- 0.42
GPCI2026.csv
85
- Locality
- Ohio
- Physician work
- 1.000
- Practice expense
- 0.913
- Malpractice
- 1.008
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.24 | × 1.000 | 3.2400 |
| Practice expense | 2.54 | × 0.913 | 2.3190 |
| Malpractice | 0.42 | × 1.008 | 0.4234 |
| Total RVUs | 5.9824 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Ohio$199.82
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.24 | 1 |
| Practice expense | 2.54 | 0.913 |
| Malpractice | 0.42 | 1.008 |
(3.24 × 1 + 2.54 × 0.913 + 0.42 × 1.008) × $33.4009 = $199.82
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.
54163 billing questions
How is repair different from a new circumcision?
Use 54163 for operative correction after a prior circumcision. Codes 54160 and 54161 describe circumcision procedures, not repair of an earlier result.
Is isolated penile adhesion release reported as a circumcision repair?
No. Code 54162 describes lysis of penile adhesions; 54163 is for repair of the circumcision itself.
What documentation supports 54163?
Document the prior circumcision, the specific residual tissue or other defect, and the operative steps used to correct it.
Are related postoperative visits included?
Yes. Related postoperative visits during the 10-day global period are included in the procedure.
Can modifier 50 or an assistant-at-surgery modifier be used?
Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery for 54163.
Can co-surgeons or a surgical team report the repair?
No. CMS lists co-surgeons and team surgery as not permitted 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.
6,25554160,,Circumcision neonate,A,,2.47,4.04,,1.16,,0.33,6.84,3.96,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,25654161,,Circum 28 days or older,A,,3.24,1.76,NA,1.76,,0.42,5.42,5.42,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,25754162,,Lysis penil circumic lesion,A,,3.24,4.25,,1.86,,0.42,7.91,5.52,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,25854163,,Repair of circumcision,A,,3.24,2.54,NA,2.54,,0.42,6.20,6.20,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,25954164,,Frenulotomy of penis,A,,2.75,2.44,NA,2.44,,0.36,5.55,5.55,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,26054200,,Injection px peyronie ds,A,,1.08,2.41,,1.28,,0.14,3.63,2.50,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,26154205,,Njx px peyronie ds exps plaq,A,,8.75,4.74,NA,4.74,,1.13,14.62,14.62,0,090,0.10,0.80,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8213282,NY,99,REST OF NEW YORK,1.000,0.950,0.703
8311502,NC,00,NORTH CAROLINA,1.000,0.933,0.639
8403302,ND,01,NORTH DAKOTA**,1.000,1.000,0.406
8515202,OH,00,OHIO,1.000,0.913,1.008
8604312,OK,00,OKLAHOMA,1.000,0.893,0.777
8702302,OR,01,PORTLAND,1.016,1.111,0.744
8802302,OR,99,REST OF OREGON,1.000,0.996,0.703