$136.03
54055 describes simple penile lesion destruction by electrosurgery. Use 54065 when the documented treatment is extensive.
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CMS RVU26D · Effective 2026-10-01
54065 Penile lesion destruction Medicare reimbursement rates in Vermont
Report extensive destruction of penile lesions, such as condylomata, when the treatment exceeds the simple lesion-destruction services in this family. Compare 54065 office and facility rates across CMS payment localities in Vermont.
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 54065 in Vermont?
Vermont 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
$217.32
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
Facility setting
$145.90
1 of 1 localities have a supported rate.
Payment area: Vermont
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.
Genital lesion treatment
About 54065: Extensive penile lesion destruction
Report extensive destruction of penile lesions, such as condylomata, when the treatment exceeds the simple lesion-destruction services in this family.
This service covers extensive destruction of penile lesions, including condylomata, molluscum contagiosum, or herpetic lesions. A urologist or other qualified clinician may perform it in an office procedure room or facility using a destructive approach such as electrosurgery, cryosurgery, laser treatment, or curettage. The code reflects extensive treatment rather than a specific instrument or a stated lesion count.
Choose this service when the documented extent of treatment is greater than the simple destruction represented by related penile lesion codes. Record the lesions treated, their location and extent, and the method used. Related postoperative visits during the 10-day global period are 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. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
CMS billing rules for 54065
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days 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
- 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 RVU2.41 · 36%
- Practice expense (office) RVU4.01 · 60%
- Malpractice RVU0.25 · 4%
1K
Medicare services in 2024 · #2935 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.
54065 compared with similar codes
Office rates for Vermont, from the same CMS release.
$140.84
54056 is for simple cryosurgical destruction of penile lesions; 54065 represents extensive destruction.
$195.83
54060 is for excision of penile lesions. Choose 54065 when lesions are destroyed rather than removed by excision.
Compare 54065 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
Vermont →
Office / nonfacility
$217.32
Facility
$145.90
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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 54065 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
6,243
- Code
- 54065
- Physician work
- 2.41
- Practice expense
- 4.01
- Malpractice
- 0.25
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.41 | × 1.000 | 2.4100 |
| Practice expense | 4.01 | × 0.990 | 3.9699 |
| Malpractice | 0.25 | × 0.506 | 0.1265 |
| Total RVUs | 6.5064 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Vermont$217.32
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.41 | 1 |
| Practice expense | 4.01 | 0.99 |
| Malpractice | 0.25 | 0.506 |
(2.41 × 1 + 4.01 × 0.99 + 0.25 × 0.506) × $33.4009 = $217.32
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.41 | 1 |
| Practice expense | 1.85 | 0.99 |
| Malpractice | 0.25 | 0.506 |
(2.41 × 1 + 1.85 × 0.99 + 0.25 × 0.506) × $33.4009 = $145.90
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.
54065 billing questions
How is this code different from simple penile lesion destruction?
Use 54065 for extensive destruction; simple destruction codes in this family are differentiated by treatment method. Document the extent of treatment rather than relying on the instrument alone.
Can modifier 50 be reported for lesions on both sides?
No. The bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
Are postoperative visits separately reported?
Related postoperative visits during the 10-day global period are included in the procedure.
How does the multiple-procedure reduction work?
For procedures performed in the same session, the highest-valued procedure is paid in full and other procedures are paid at 50% under the standard multiple-procedure reduction.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service. 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.
6,24054056,,Cryosurgery penis lesion(s),A,,1.26,2.92,,1.58,,0.13,4.31,2.97,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,24154057,,Laser surg penis lesion(s),A,,1.26,2.89,,1.31,,0.16,4.31,2.73,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,24254060,,Excision of penis lesion(s),A,,1.93,3.85,,1.50,,0.24,6.02,3.67,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,24354065,,Destruction penis lesion(s),A,,2.41,4.01,,1.85,,0.25,6.67,4.51,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,24454100,,Biopsy of penis,A,,1.85,4.03,,1.06,,0.20,6.08,3.11,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,24554105,,Biopsy of penis,A,,3.45,4.67,,1.96,,0.44,8.56,5.85,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817