$255.85
Use 54164 for release of the penile frenulum. Use 54162 for lysis of penile adhesions.
On this page
CMS RVU26D · Effective 2026-10-01
54164 Frenulotomy Medicare reimbursement rates in Vermont
Reports surgical release of a short or tethered penile frenulum, typically performed to relieve restricted movement or discomfort. Compare 54164 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 54164 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
No supported rate
Facility setting
$178.62
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.
Urology procedure
About 54164: Penile frenulum release
Reports surgical release of a short or tethered penile frenulum, typically performed to relieve restricted movement or discomfort.
A penile frenulotomy releases a tight band of tissue connecting the underside of the glans to the foreskin. Urologists commonly perform it for a short or tethered frenulum that restricts foreskin movement or causes discomfort, including during erection. The service may be performed in an operating room or another appropriate procedural setting; document the frenular finding and the release performed.
Report 54164 for the frenular release itself, not for circumcision or lysis of penile adhesions. The operative note should identify the frenulum as the treated structure and describe the incision or release. Medicare assigns a 10-day global period, so related postoperative visits during that period are included. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this code; co-surgeons and team surgery are not permitted.
CMS billing rules for 54164
- 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 RVU2.75 · 50%
- Practice expense (office) RVU2.44 · 44%
- Malpractice RVU0.36 · 6%
61
Medicare services in 2024 · #5231 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.
54164 compared with similar codes
Office rates for Vermont, from the same CMS release.
$221.67
54160 reports circumcision in a neonate; 54164 reports release of the penile frenulum, not removal of the foreskin.
No office rate
54161 reports circumcision at age 28 days or older. Choose 54164 when the service is frenular release rather than circumcision.
Compare 54164 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
Unavailable
Facility
$178.62
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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 54164 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
6,259
- Code
- 54164
- Physician work
- 2.75
- Practice expense
- 2.44
- Malpractice
- 0.36
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.75 | × 1.000 | 2.7500 |
| Practice expense | 2.44 | × 0.990 | 2.4156 |
| Malpractice | 0.36 | × 0.506 | 0.1822 |
| Total RVUs | 5.3478 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$178.62
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.75 | 1 |
| Practice expense | 2.44 | 0.99 |
| Malpractice | 0.36 | 0.506 |
(2.75 × 1 + 2.44 × 0.99 + 0.36 × 0.506) × $33.4009 = $178.62
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.
54164 billing questions
How is 54164 different from lysis of penile adhesions?
54164 releases the penile frenulum, the tissue band beneath the glans. Code 54162 describes lysis of penile adhesions, a different anatomic problem.
Can 54164 be reported with a circumcision code?
A separate frenular release may be performed during the same session as circumcision. Document the distinct frenular problem and work; do not treat the circumcision itself as the frenulotomy.
What documentation supports 54164?
Document the short or tethered frenulum, the clinical reason for release, and the specific release performed. The record should distinguish this work from circumcision or treatment of adhesions.
Does 54164 have a postoperative global period?
Yes. The 10-day global period includes related postoperative visits during those 10 days.
Can modifier 50 or an assistant-at-surgery modifier be used?
Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for 54164.
How does Medicare handle 54164 with another procedure in the same session?
The highest-valued procedure is paid in full, and other procedures in the session are subject to the standard multiple-procedure reduction. Co-surgeons and team surgery are not permitted for 54164.
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.
6,25654161,,Circum 28 days or older,A,,3.24,1.76,NA,1.76,,0.42,5.42,5.42,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,25754162,,Lysis penil circumic lesion,A,,3.24,4.25,,1.86,,0.42,7.91,5.52,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,25854163,,Repair of circumcision,A,,3.24,2.54,NA,2.54,,0.42,6.20,6.20,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,25954164,,Frenulotomy of penis,A,,2.75,2.44,NA,2.44,,0.36,5.55,5.55,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,26054200,,Injection px peyronie ds,A,,1.08,2.41,,1.28,,0.14,3.63,2.50,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,26154205,,Njx px peyronie ds exps plaq,A,,8.75,4.74,NA,4.74,,1.13,14.62,14.62,0,090,0.10,0.80,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
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