No office rate
Use 54110 for plaque excision without grafting. Use 54115 when the operation includes graft reconstruction and harvesting graft tissue.
On this page
CMS RVU26D · Effective 2026-10-01
54115 Penile plaque surgery Medicare reimbursement rates in Rhode Island
Surgical excision of a Peyronie’s plaque with graft reconstruction and graft harvesting, reported when the operative repair includes harvesting tissue for the graft. Compare 54115 office and facility rates across CMS payment localities in Rhode Island.
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 54115 in Rhode Island?
Rhode Island 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
$484.35
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
Facility setting
$401.89
1 of 1 localities have a supported rate.
Payment area: Rhode Island
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 surgery
About 54115: Penile plaque excision with graft harvest
Surgical excision of a Peyronie’s plaque with graft reconstruction and graft harvesting, reported when the operative repair includes harvesting tissue for the graft.
This operation treats Peyronie’s disease by removing a penile plaque and reconstructing the resulting defect with graft tissue harvested during the procedure. A urologist typically performs the surgery in an operating room when the operative plan calls for plaque excision and graft repair rather than a diagnostic biopsy or plaque excision without grafting.
Select the code from the documented operative work, including plaque excision, graft reconstruction, and graft harvesting. The operative report should identify the plaque treatment, graft use, and harvest. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. 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 50% multiple-procedure reduction. Do not use modifier 50; CMS permits assistant-at-surgery payment but not co-surgeon or team-surgery billing.
CMS billing rules for 54115
- 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 not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU6.78 · 48%
- Practice expense (office) RVU6.59 · 46%
- Malpractice RVU0.88 · 6%
34
Medicare services in 2024 · #5588 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.
54115 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
No office rate
54111 applies to plaque excision with a dermal or synthetic graft; 54115 includes graft harvesting as part of the operation.
No office rate
54112 applies to plaque excision with a vein graft. For the graft-harvest procedure represented by 54115, the operative report must support harvesting as part of the repair.
$207.97
54100 is for penile tissue sampling to establish a diagnosis. It does not represent excision of a Peyronie’s plaque with graft reconstruction.
Compare 54115 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
Rhode Island →
Office / nonfacility
$484.35
Facility
$401.89
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 54115 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
6,249
- Code
- 54115
- Physician work
- 6.78
- Practice expense
- 6.59
- Malpractice
- 0.88
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 6.78 | × 1.019 | 6.9088 |
| Practice expense | 6.59 | × 1.033 | 6.8075 |
| Malpractice | 0.88 | × 0.892 | 0.7850 |
| Total RVUs | 14.5012 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Rhode Island$484.35
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 6.78 | 1.019 |
| Practice expense | 6.59 | 1.033 |
| Malpractice | 0.88 | 0.892 |
(6.78 × 1.019 + 6.59 × 1.033 + 0.88 × 0.892) × $33.4009 = $484.35
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 6.78 | 1.019 |
| Practice expense | 4.2 | 1.033 |
| Malpractice | 0.88 | 0.892 |
(6.78 × 1.019 + 4.2 × 1.033 + 0.88 × 0.892) × $33.4009 = $401.89
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.
54115 billing questions
How does this differ from 54110?
54115 includes graft reconstruction with graft harvesting as part of the plaque operation. 54110 is for plaque excision without grafting.
Is graft harvesting separately reported?
Graft harvesting is included in 54115. The operative report should support that graft tissue was harvested and used in the reconstruction.
Can modifier 50 be used for bilateral disease?
No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 is not used.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
CMS allows payment for an assistant at surgery. Co-surgeons and team surgery are not permitted for this code.
When is a biopsy code more appropriate?
Use a penile biopsy code when the service is tissue sampling for diagnosis rather than plaque excision with graft reconstruction.
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.
6,24654110,,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
6,24954115,,Treatment of penis lesion,A,,6.78,6.59,,4.20,,0.88,14.25,11.86,0,090,0.10,0.80,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,25054120,,Partial removal of penis,A,,10.73,5.14,NA,5.14,,1.39,17.26,17.26,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,25154125,,Removal of penis,A,,14.20,6.21,NA,6.21,,1.96,22.37,22.37,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,25254130,,Remove penis & nodes,A,,21.29,7.96,NA,7.96,,2.74,31.99,31.99,0,090,0.10,0.80,0.10,2,2,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537