Billing code 54416: Penile prosthesisMedicare rate & RVUs in Ohio
Urologists report this service when they remove and replace a non-inflatable, semi-rigid penile prosthesis during the same operative session.
CMS doesn’t publish an office rate for 54416 in Ohio.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 54416 covers
A urologist removes an existing semi-rigid penile implant and places a replacement during the same operation. These devices use bendable rods rather than an inflatable pump system and are used to treat erectile dysfunction. The procedure is generally performed in a hospital or ambulatory surgery setting when the implanted device needs replacement, such as because of malfunction or another clinical concern.
Report this code for the same-session removal and replacement of a non-inflatable device; the operative report should identify the prosthesis type and document both removal and replacement. Extensive urethral or bladder repair points to the more complex related code, 54417. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
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.
54416 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | Unavailable | $637.00 |
How the 54416 rate is calculated
Each of 54416’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 54416
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 11.78Practice expense 6.33Malpractice 1.50
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 54416
54416 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 54416
Penile prosthesis
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 54416
Penile prosthesis
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
54416 without 51 · national facility
$654.99
Penile prosthesis
54416-51 · Second procedure: 50%
$327.50
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
54416 compared with similar codes
Compare codes
54416 vs 54415 vs 54417 vs 54410: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 54415Prosthesis removal
- 54415 is removal without replacement. Choose 54416 when a new semi-rigid prosthesis is placed during the same operative session.
- 54417Penile prosthesis
- 54417 identifies the more complex semi-rigid replacement involving extensive urethral or bladder repair; 54416 describes replacement without that added complexity.
- 54410Prosthesis replacement
- 54410 is for removal and replacement of a multi-component inflatable prosthesis. This code is for a non-inflatable, semi-rigid device.
54416 billing questions
How is this different from code 54415?
Use 54416 when the semi-rigid prosthesis is removed and replaced in the same operative session. Code 54415 describes removal without replacement.
Should removal and insertion be billed as separate procedures?
No. This code describes the same-session removal and replacement of the semi-rigid device; document both parts of the operation.
When should code 54417 be considered?
Use 54417 for the more complex semi-rigid prosthesis replacement involving extensive urethral or bladder repair.
Can modifier 50 be used?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this service.
What global-period services are included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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