No office rate
54308 describes urethral reconstruction. Use 54328 when the documented operation involves complex reconstruction of both penile and urethral anatomy.
On this page
CMS RVU26D · Effective 2026-10-01
54328 Penile reconstruction Medicare reimbursement rates in Pennsylvania
Reports complex operative reconstruction involving the penis and urethra, with code selection supported by the documented anatomy and surgical work. Compare 54328 office and facility rates across CMS payment localities in Pennsylvania.
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 54328 in Pennsylvania?
Pennsylvania 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
$820.62–$875.37
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.
Urologic surgery
About 54328: Complex penile and urethral reconstruction
Reports complex operative reconstruction involving the penis and urethra, with code selection supported by the documented anatomy and surgical work.
This code represents complex reconstructive surgery involving penile and urethral anatomy, rather than a repair limited to one structure. A urologist typically performs the operation in a hospital or other surgical setting. The operative report should make clear the condition being corrected, the structures addressed, and the reconstructive steps performed. Hypospadias-related reconstruction may be part of this clinical context, but the code should be selected based on the actual procedure and its documented scope.
The code has a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included. 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 for this code. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted. The operative note should distinguish this combined penile and urethral reconstruction from a procedure addressing only the urethra, a specific hypospadias repair, or a limited penile revision.
CMS billing rules for 54328
- 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 RVU16.47 · 65%
- Practice expense (office) RVU6.64 · 26%
- Malpractice RVU2.12 · 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.
54328 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
No office rate
Both codes concern penile and urethral revision. Choose between them using the exact procedure performed and the operative details, not the abbreviated CMS label alone.
No office rate
54352 specifically addresses revision of a previously repaired hypospadias. It is not interchangeable with this code solely because the operation involves penile and urethral reconstruction.
Compare 54328 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
Metropolitan Philadelphia →
Office / nonfacility
Unavailable
Facility
$875.37
Rest Of Pennsylvania →
Office / nonfacility
Unavailable
Facility
$820.62
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54328 billing questions
What documentation supports reporting this code?
Document the condition treated, the penile and urethral structures involved, and the reconstructive work performed. The operative report should establish why the procedure is more than an isolated urethral reconstruction or limited penile repair.
Can modifier 50 be used?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How is another procedure in the same session handled?
Under the standard multiple-procedure rule, the highest-valued procedure is paid in full and other procedures are subject to a 50% reduction. The operative documentation should support each separately reported procedure.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is provided; team surgery is not permitted.
What care is included in the global period?
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 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.
6,27854322,,Reconstruction of urethra,A,,13.63,5.72,NA,5.72,,1.75,21.10,21.10,0,090,0.10,0.80,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,27954324,,Reconstruction of urethra,A,,17.11,6.74,NA,6.74,,2.19,26.04,26.04,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,28054326,,Reconstruction of urethra,A,,16.59,6.66,NA,6.66,,2.13,25.38,25.38,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,28154328,,Revise penis/urethra,A,,16.47,6.64,NA,6.64,,2.12,25.23,25.23,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,28254332,,Revise penis/urethra,A,,17.91,6.93,NA,6.93,,2.31,27.15,27.15,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,28354336,,Revise penis/urethra,A,,21.08,8.08,NA,8.08,,2.71,31.87,31.87,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,28454340,,Rpr hypspad comp simple,A,,9.47,4.90,NA,4.90,,1.22,15.59,15.59,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00