$187.18
54100 represents a simpler penile biopsy. Use 54105 when the documented service obtains deeper penile tissue.
On this page
CMS RVU26D · Effective 2026-10-01
54105 Penile biopsy Medicare reimbursement rates in Oklahoma
Report this service when a clinician obtains a deep penile tissue sample for histologic evaluation of a lesion or abnormal tissue. Compare 54105 office and facility rates across CMS payment localities in Oklahoma.
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 54105 in Oklahoma?
Oklahoma 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
$265.94
1 of 1 localities have a supported rate.
Payment area: Oklahoma
One mapped payment locality.
Facility setting
$185.11
1 of 1 localities have a supported rate.
Payment area: Oklahoma
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
About 54105: Deep penile tissue biopsy
Report this service when a clinician obtains a deep penile tissue sample for histologic evaluation of a lesion or abnormal tissue.
This service involves sampling deeper tissue of the penis for diagnosis, commonly when an abnormal lesion needs histologic evaluation and a superficial sample would not provide the needed tissue. Urologists typically perform it in an office, procedure room, or operating room, depending on the lesion and the method required. The specimen is sent for pathologic examination; a suspicious lesion may be evaluated for malignancy or another tissue abnormality.
Choose this code for a deep biopsy rather than the simpler penile biopsy represented by 54100. The procedure note should identify the sampled site, describe the lesion and biopsy approach, and support why deeper tissue was obtained. Medicare assigns a 10-day global period, so related postoperative visits during that period are included. 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 50% multiple-procedure reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this procedure, and co-surgeons and team surgery are not permitted.
CMS billing rules for 54105
- 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 RVU3.45 · 40%
- Practice expense (office) RVU4.67 · 55%
- Malpractice RVU0.44 · 5%
135
Medicare services in 2024 · #4639 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.
54105 compared with similar codes
Office rates for Oklahoma, from the same CMS release.
No office rate
54110 is a lesion-treatment service, while 54105 is performed to obtain tissue for diagnosis.
Compare 54105 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
Oklahoma →
Office / nonfacility
$265.94
Facility
$185.11
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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 54105 in Oklahoma.
PPRRVU2026_Oct_nonQPP.csv
6,245
- Code
- 54105
- Physician work
- 3.45
- Practice expense
- 4.67
- Malpractice
- 0.44
GPCI2026.csv
86
- Locality
- Oklahoma
- Physician work
- 1.000
- Practice expense
- 0.893
- Malpractice
- 0.777
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.45 | × 1.000 | 3.4500 |
| Practice expense | 4.67 | × 0.893 | 4.1703 |
| Malpractice | 0.44 | × 0.777 | 0.3419 |
| Total RVUs | 7.9622 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Oklahoma$265.94
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.45 | 1 |
| Practice expense | 4.67 | 0.893 |
| Malpractice | 0.44 | 0.777 |
(3.45 × 1 + 4.67 × 0.893 + 0.44 × 0.777) × $33.4009 = $265.94
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.45 | 1 |
| Practice expense | 1.96 | 0.893 |
| Malpractice | 0.44 | 0.777 |
(3.45 × 1 + 1.96 × 0.893 + 0.44 × 0.777) × $33.4009 = $185.11
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.
54105 billing questions
How is 54105 distinguished from 54100?
Use 54105 for a deep penile tissue biopsy; 54100 represents a simpler penile biopsy. The operative note should support the depth and approach performed.
Is this code for removing a penile lesion?
It represents obtaining tissue for diagnosis, not lesion-directed treatment. A procedure intended to treat or remove a lesion should be evaluated under the applicable treatment code, such as 54110.
Can modifier 50 be used for biopsies on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code.
Are related postoperative visits separately payable during the global period?
Related postoperative visits during the 10-day global period are included in the procedure.
What happens when another procedure is performed in the same session?
The highest-valued procedure is paid in full, while other procedures are subject to the standard multiple-procedure reduction.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this procedure. Co-surgeons and team surgery are not permitted.
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.
6,24254060,,Excision of penis lesion(s),A,,1.93,3.85,,1.50,,0.24,6.02,3.67,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,24354065,,Destruction penis lesion(s),A,,2.41,4.01,,1.85,,0.25,6.67,4.51,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,24454100,,Biopsy of penis,A,,1.85,4.03,,1.06,,0.20,6.08,3.11,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,24554105,,Biopsy of penis,A,,3.45,4.67,,1.96,,0.44,8.56,5.85,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,24654110,,Treatment of penis lesion,A,,10.65,5.01,NA,5.01,,1.36,17.02,17.02,0,090,0.10,0.80,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,24754111,,Treat penis lesion graft,A,,14.06,5.71,NA,5.71,,1.80,21.57,21.57,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,24854112,,Treat penis lesion graft,A,,16.56,6.56,NA,6.56,,2.13,25.25,25.25,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193