$124.08
Use 54235 for pharmacologic injection into the corpora cavernosa. Code 54200 addresses injection treatment for Peyronie’s disease.
On this page
CMS RVU26D · Effective 2026-10-01
54235 Penile injection Medicare reimbursement rates in Rhode Island
Reports injection of a pharmacologic agent into the corpora cavernosa, commonly to induce an erection during evaluation of erectile dysfunction. Compare 54235 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 54235 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
$96.74
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
Facility setting
$69.14
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 procedure
About 54235: Intracavernosal pharmacologic injection
Reports injection of a pharmacologic agent into the corpora cavernosa, commonly to induce an erection during evaluation of erectile dysfunction.
A clinician injects a pharmacologic agent into the corpora cavernosa to produce an erection, commonly as part of an evaluation for erectile dysfunction. Urologists typically perform the procedure in an office or outpatient setting. The service centers on administration of the agent into the erectile tissue; it is distinct from injecting medication into a Peyronie’s plaque or irrigating the corpora for priapism.
Documentation should identify the clinical reason, the agent administered, the injection, and the observed response when assessed. The code has a 0-day global period, so same-day preoperative and postoperative care is included. 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 for this service. Medicare does not pay an assistant at surgery for it; co-surgeons and team surgery are not permitted.
CMS billing rules for 54235
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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 RVU1.16 · 41%
- Practice expense (office) RVU1.53 · 54%
- Malpractice RVU0.15 · 5%
15.7K
Medicare services in 2024 · #1239 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.
54235 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
$257.37
54220 is irrigation of the corpora cavernosa for priapism; 54235 is pharmacologic injection for an erectile-function evaluation.
$112.79
54235 reports pharmacologic injection into the corpora cavernosa. Code 54230 is the injection procedure for cavernosography.
$151.78
54231 reports dynamic cavernosometry, which measures penile pressure. 54235 reports the pharmacologic injection itself.
Compare 54235 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
$96.74
Facility
$69.14
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 54235 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
6,265
- Code
- 54235
- Physician work
- 1.16
- Practice expense
- 1.53
- Malpractice
- 0.15
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.16 | × 1.019 | 1.1820 |
| Practice expense | 1.53 | × 1.033 | 1.5805 |
| Malpractice | 0.15 | × 0.892 | 0.1338 |
| Total RVUs | 2.8963 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Rhode Island$96.74
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.16 | 1.019 |
| Practice expense | 1.53 | 1.033 |
| Malpractice | 0.15 | 0.892 |
(1.16 × 1.019 + 1.53 × 1.033 + 0.15 × 0.892) × $33.4009 = $96.74
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.16 | 1.019 |
| Practice expense | 0.73 | 1.033 |
| Malpractice | 0.15 | 0.892 |
(1.16 × 1.019 + 0.73 × 1.033 + 0.15 × 0.892) × $33.4009 = $69.14
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.
54235 billing questions
How does this differ from a Peyronie’s disease injection?
54235 describes pharmacologic injection into the corpora cavernosa, commonly to assess erectile response. Code 54200 is for injection treatment directed at Peyronie’s disease.
Is modifier 50 appropriate when both sides are injected?
No. The CMS bilateral adjustment does not apply to 54235, and modifier 50 is inappropriate.
What same-day care is included?
The 0-day global period includes same-day preoperative and postoperative care. The pharmacologic injection itself is the service reported.
How are other procedures handled in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction. The rule applies when procedures are performed in the same session.
Can an assistant or another surgeon be reported?
Medicare does not pay an assistant at surgery for 54235. 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.
6,26254220,,Irrg crpra cavrnosa priapism,A,,2.36,4.76,,1.09,,0.43,7.55,3.88,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,26354230,,Njx corpora cavernosograpy,A,,1.31,1.83,,0.71,,0.17,3.31,2.19,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,26454231,,Dynamic cavernosometry,A,,1.99,2.22,,0.90,,0.25,4.46,3.14,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,26554235,,Njx corpora cavernosa rx agt,A,,1.16,1.53,,0.73,,0.15,2.84,2.04,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,26654240,,Penile plethysmography,A,,1.28,1.91,,1.91,NA,0.20,3.39,3.39,1,000,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,26754240,26,Penile plethysmography,A,,1.28,0.53,,0.53,,0.18,1.99,1.99,1,000,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,26854240,TC,Penile plethysmography,A,,0.00,1.38,,1.38,NA,0.02,1.40,1.40,1,000,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,02,0,99,0.00,0.00,0.00
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