CPT code 54400: Penile prosthesis2026 Medicare rate & RVUs in Texas
Reports surgical placement of a semi-rigid penile prosthesis for erectile dysfunction when a non-inflatable implant is selected.
CMS doesn’t publish an office rate for 54400 in Texas.
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 54400 covers
A urologist places bendable, non-inflatable rods within the penile erectile bodies to provide penile rigidity. This operation is used for erectile dysfunction when a semi-rigid device is selected, including situations in which a patient prefers a simpler implant that does not require an inflation pump. It is generally performed in a surgical setting, with the operative record identifying the device type and documenting placement.
Select this code for initial insertion of a semi-rigid prosthesis, not an inflatable device or an exchange of an existing implant. Documentation should support the indication, the implant type, and the procedure performed. The CMS global period is 90 days, including the day-before preoperative visit and related postoperative care. 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 multiple procedure reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery; co-surgeons require 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 54400 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Unavailable | $489.78 |
| Beaumont | Unavailable | $468.94 |
| Brazoria | Unavailable | $477.59 |
| Dallas | Unavailable | $481.62 |
| Fort Worth | Unavailable | $480.64 |
| Galveston | Unavailable | $479.73 |
| Houston | Unavailable | $500.78 |
| Rest Of Texas | Unavailable | $473.71 |
How the 54400 rate is calculated
Each of 54400’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 · 54400
RVUs × geographic indexes × conversion factor
Work8.94
8.94 RVUs× 1.000 GPCI
Practice expense4.43
4.43 RVUs× 1.000 GPCI
Malpractice1.15
1.15 RVUs× 1.000 GPCI
Adjusted RVUs
14.5200
Conversion factor
$33.4009
Medicare rate
$484.98
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 54400
54400 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 54400
Penile prosthesis
| 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) | 1 | Not paid (statutory restriction). |
| 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 · 54400
Penile prosthesis
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
54400 without 51 · national facility
$484.98
Penile prosthesis
54400-51 · Second procedure: 50%
$242.49
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%).
54400 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 54401Penile prosthesis
- Choose 54401 when the inserted device is an inflatable, self-contained prosthesis; use 54400 for a semi-rigid, non-inflatable device.
- 54405Penile prosthesis
- Code 54405 describes insertion of a multi-component prosthesis. Code 54400 is for a semi-rigid implant.
- 54410Prosthesis replacement
- Code 54410 is for removal and replacement of all components of a non-inflatable prosthesis. Code 54400 is for insertion, not exchange, of a semi-rigid implant.
54400 billing questions
How is this code distinguished from 54401?
This code is for a semi-rigid, non-inflatable implant. Code 54401 is for an inflatable prosthesis with a self-contained design.
When should 54405 be considered instead?
Use 54405 for insertion of a multi-component penile prosthesis. This code describes placement of a semi-rigid implant.
Can modifier 50 be reported?
No. CMS 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.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeons are paid only when supporting documentation is provided.
How does a same-session second procedure affect payment?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple procedure reduction.
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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