Billing code 54406: Penile prosthesis removalMedicare rate & RVUs in Oregon
Report removal of all components of a multicomponent inflatable penile prosthesis when the device is explanted and no replacement prosthesis is inserted.
CMS doesn’t publish an office rate for 54406 in Oregon.
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 54406 covers
This operation removes the complete implanted system of a multicomponent inflatable penile prosthesis, including its cylinders, pump, and reservoir. Urologists typically perform it in a hospital or ambulatory surgery setting when the device must be explanted, such as for infection, erosion, malfunction, or another clinical reason. The defining distinction is that the prosthesis is removed without replacement during the same operative session; removal of only part of the system is not the service described by this code.
Report the code when the operative record supports removal of all components and confirms that no replacement prosthesis was inserted in that session. If all components are removed and replaced during the operation, consider the applicable removal-and-replacement code instead. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur 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. Assistant-at-surgery payment may be made; 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.
Where 54406 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $677.85 |
| Rest Of Oregon | Unavailable | $647.08 |
How the 54406 rate is calculated
Each of 54406’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 · 54406
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 12.57Practice expense 5.68Malpractice 1.63
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 54406
54406 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 54406
Penile prosthesis removal
| 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 · 54406
Penile prosthesis removal
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
54406 without 51 · national facility
$664.01
Penile prosthesis removal
54406-51 · Second procedure: 50%
$332.01
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%).
54406 compared with similar codes
Compare codes
54406 vs 54410 vs 54411 vs 54415 vs 54408: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 54410Prosthesis replacement
- 54406 describes complete removal without replacement. 54410 is the removal-and-replacement option when all components are exchanged in the same session.
- 54411Prosthesis exchange
- Both involve removal and replacement of a multicomponent inflatable prosthesis; use 54411 when its additional criteria are documented, rather than for removal alone.
- 54415Prosthesis removal
- 54415 is for removal of a self-contained inflatable prosthesis. 54406 is for removal of all components of a multicomponent inflatable system.
- 54408Prosthesis repair
- 54408 describes repair of an inflatable prosthesis. Choose 54406 when the complete multicomponent device is removed without replacement, not when it is repaired.
54406 billing questions
When should this code be used instead of 54410?
Use 54406 when all components of a multicomponent inflatable prosthesis are removed and no prosthesis is replaced in that session. When all components are removed and replaced during the same operation, consider 54410 or the applicable more complex removal-and-replacement code.
Does this code include removal of the pump and reservoir?
Yes. The service is removal of the complete multicomponent system, including its cylinders, pump, and reservoir. Document which components were removed.
Can modifier 50 be reported?
No. Medicare 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.
How does Medicare handle another procedure performed in the same session?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50% when performed in the same session.
What documentation supports reporting this code?
The operative report should establish the multicomponent inflatable device, removal of all of its components, and that no replacement prosthesis was inserted during the session.
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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