Billing code 54328: Penile reconstructionMedicare rate & RVUs in Utah
Reports complex operative reconstruction involving the penis and urethra, with code selection supported by the documented anatomy and surgical work.
CMS doesn’t publish an office rate for 54328 in Utah.
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 54328 covers
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.
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 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | Unavailable | $822.18 |
How the 54328 rate is calculated
Each of 54328’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 · 54328
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 16.47Practice expense 6.64Malpractice 2.12
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 54328
54328 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 54328
Penile reconstruction
| 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) | 2 | Paid. |
| 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 · 54328
Penile reconstruction
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
54328 without 51 · national facility
$842.70
Penile reconstruction
54328-51 · Second procedure: 50%
$421.35
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%).
54328 compared with similar codes
Compare codes
54328 vs 54308 vs 54332 vs 54352: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 54308Urethral reconstruction
- 54308 describes urethral reconstruction. Use 54328 when the documented operation involves complex reconstruction of both penile and urethral anatomy.
- 54332Penile revision
- 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.
- 54352Hypospadias revision
- 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.
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 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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