Billing code 54200: Plaque injectionMedicare rate & RVUs in Utah
A urologist injects medication into a penile plaque to treat Peyronie's disease, rather than injecting the corpora cavernosa for diagnostic testing.
Medicare pays $115.94 for 54200 in the office in Utah (Utah). Which amount applies depends on the service address.
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 54200 covers
A urologist uses this code for a therapeutic injection directed into the fibrous penile plaque associated with Peyronie's disease. The service is commonly performed in an office or other outpatient setting for a patient with penile curvature or deformity from plaque. The injection targets the plaque; it is distinct from medication injected into the corpora cavernosa to assess erectile response. When a separately reportable drug is supplied, its billing is distinct from the injection procedure.
Report the service when the record supports treatment of Peyronie's plaque and documents the injection performed. The code has a 10-day global period, so related postoperative visits during that period are included. If 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% reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are 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.
54200 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | $115.94 | $80.46 |
How the 54200 rate is calculated
Each of 54200’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 · 54200
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.08Practice expense 2.41Malpractice 0.14
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 54200
54200 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 54200
Plaque injection
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 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) | 0 | Not permitted. |
| 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 · 54200
Plaque injection
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
54200 without 51 · national office
$121.25
Plaque injection
54200-51 · Second procedure: 50%
$60.63
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%).
54200 compared with similar codes
Compare codes
54200 vs 54205 vs 54235 vs 54230: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 54205Plaque injection
- Use 54205 when the plaque is surgically exposed for injection; 54200 is for plaque injection without that exposure.
- 54235Penile injection
- 54235 is an injection of a pharmacologic agent into the corpora cavernosa, commonly for erectile-response assessment; 54200 treats a Peyronie's plaque.
- 54230Cavernosography
- 54230 describes injection for cavernosography, a diagnostic imaging study of the corpora cavernosa, rather than therapeutic injection into a Peyronie's plaque.
54200 billing questions
How does 54200 differ from 54205?
54200 describes injection treatment without surgical exposure of the plaque. 54205 is the related code for injection performed with surgical exposure of the plaque.
Can the medication be billed separately?
The injection procedure and a separately reportable drug are distinct items. Report a drug code only when the drug was supplied and the applicable drug billing requirements are met.
Is modifier 50 appropriate for multiple plaques or both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; do not use modifier 50.
What documentation supports 54200?
Document Peyronie's disease, the plaque treated, the therapeutic injection performed, and the clinical context supporting plaque-directed treatment.
Are related follow-up visits included?
Yes. Related postoperative visits during the 10-day global period are included in the procedure payment.
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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