No office rate
Choose 54400 for a semi-rigid implant that does not inflate; 54401 is for an inflatable self-contained device.
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CMS RVU26D · Effective 2026-10-01
54401 Penile prosthesis Medicare reimbursement rates in Vermont
Reports operative placement of a self-contained inflatable penile prosthesis, typically for erectile dysfunction when a patient chooses surgical treatment. Compare 54401 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 54401 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
$593.63
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 surgery
About 54401: Self-contained inflatable penile prosthesis insertion
Reports operative placement of a self-contained inflatable penile prosthesis, typically for erectile dysfunction when a patient chooses surgical treatment.
A urologist places an inflatable penile implant whose inflation mechanism is self-contained, rather than using a separate pump and reservoir. The procedure is generally performed in an operating room for erectile dysfunction when the patient and surgeon select an implant after considering other treatment options. The device type distinguishes this service from placement of a semi-rigid implant or a multi-component inflatable system.
Report 54401 for initial implantation of the self-contained inflatable device, and document the indication, device type, and operative placement. Medicare assigns major-surgery global status: 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 50% reduction. Modifier 50 is inappropriate for this descriptor and anatomy. Medicare does not pay an assistant at surgery under the stated statutory restriction; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 54401
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care 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 paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU10.18 · 55%
- Practice expense (office) RVU7.00 · 38%
- Malpractice RVU1.31 · 7%
43
Medicare services in 2024 · #5454 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.
54401 compared with similar codes
Office rates for Vermont, from the same CMS release.
No office rate
Choose 54405 when the inflatable implant is multi-component. The self-contained inflation mechanism identifies 54401.
No office rate
54416 describes removal and replacement of an existing self-contained or semi-rigid prosthesis; 54401 is for implantation, not an exchange.
No office rate
54415 is for removing a prosthesis without replacement. Report 54401 for initial placement of the self-contained inflatable device.
Compare 54401 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
$593.63
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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 54401 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
6,293
- Code
- 54401
- Physician work
- 10.18
- Practice expense
- 7.00
- Malpractice
- 1.31
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 10.18 | × 1.000 | 10.1800 |
| Practice expense | 7.00 | × 0.990 | 6.9300 |
| Malpractice | 1.31 | × 0.506 | 0.6629 |
| Total RVUs | 17.7729 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$593.63
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 10.18 | 1 |
| Practice expense | 7 | 0.99 |
| Malpractice | 1.31 | 0.506 |
(10.18 × 1 + 7 × 0.99 + 1.31 × 0.506) × $33.4009 = $593.63
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.
54401 billing questions
How does 54401 differ from 54400?
54401 is for an inflatable, self-contained prosthesis. 54400 is for a non-inflatable, semi-rigid prosthesis.
When should 54405 be reported instead?
Use 54405 for an inflatable multi-component prosthesis, which has separate system components rather than a self-contained inflation mechanism.
Can modifier 50 be appended?
No. Modifier 50 is inappropriate for this descriptor and anatomy.
What postoperative care is included in the global period?
The day-before preoperative visit and 90 days of related postoperative care are included in the major-surgery global period.
How is 54401 handled when other procedures occur in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple procedure reduction. Medicare does not pay an assistant at surgery; co-surgeon payment requires supporting documentation.
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.
6,29054385,,Repair penis,A,,16.15,6.92,NA,6.92,,2.08,25.15,25.15,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,29154390,,Repair penis and bladder,A,,22.20,8.18,NA,8.18,,2.86,33.24,33.24,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,29254400,,Insert semi-rigid prosthesis,A,,8.94,4.43,NA,4.43,,1.15,14.52,14.52,0,090,0.10,0.80,0.10,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,29354401,,Insert self-contd prosthesis,A,,10.18,7.00,NA,7.00,,1.31,18.49,18.49,0,090,0.10,0.80,0.10,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,29454405,,Insert multi-comp penis pros,A,,14.16,5.84,NA,5.84,,1.82,21.82,21.82,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,29554406,,Remove muti-comp penis pros,A,,12.57,5.68,NA,5.68,,1.63,19.88,19.88,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,29654408,,Repair multi-comp penis pros,A,,13.56,6.19,NA,6.19,,1.75,21.50,21.50,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,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