Billing code 54250: Nocturnal erection testingMedicare rate & RVUs in Washington
Reports overnight measurement of penile tumescence and rigidity to evaluate erectile dysfunction and help distinguish sleep-related erectile responses.
Medicare pays $125.20–$135.99 for 54250 in the office in Washington, from Rest Of Washington to Seattle (King Cnty). 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 54250 covers
This test monitors changes in penile size and rigidity during sleep, typically overnight, as part of an evaluation for erectile dysfunction. A urology practice may arrange the study, with staff applying or setting up monitoring equipment and a qualified clinician interpreting the recorded results. The findings can help assess whether normal sleep-related erections occur; they are considered alongside the patient’s history and other evaluation findings.
Report the study when nocturnal tumescence and rigidity are measured and interpreted, rather than for penile plethysmography or an invasive vascular study. Documentation should identify the erectile dysfunction evaluation, describe the study performed, and include the recorded findings and interpretation. Modifier 26 identifies the professional interpretation, TC identifies the technical service, and an unmodified claim represents the global service. The 0-day global includes same-day preoperative and postoperative care. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; 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.
Where 54250 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | $125.20 | Unavailable |
| Seattle (King Cnty) | $135.99 | Unavailable |
How the 54250 rate is calculated
Each of 54250’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 · 54250
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.16Practice expense 1.33Malpractice 0.21
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 54250
The CMS indicators that decide how 54250 is paid alongside other services.
CMS payment indicators · 54250
Nocturnal erection testing
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 1 | Diagnostic test with separate professional (26) and technical (TC) components. |
What modifiers do to the payment
Modifier 26 · payment effect
With and without the modifier
54250 without 26 · national office
$123.58
Nocturnal erection testing
54250-26 · Professional component
$108.89
Pays only the interpretation and report.
54250 compared with similar codes
Compare codes
54250 vs 54240 vs 54230 vs 54231: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 54240Penile plethysmography
- Choose 54250 for overnight recording of penile tumescence and rigidity during sleep. Code 54240 describes penile plethysmography, a separate testing method.
- 54230Cavernosography
- Code 54230 is for cavernosography, an invasive imaging assessment of penile vascular anatomy; it does not report nocturnal monitoring.
- 54231Cavernosometry
- Code 54231 reports dynamic cavernosometry, an invasive vascular assessment. Code 54250 measures tumescence and rigidity during sleep.
54250 billing questions
How does this differ from penile plethysmography, code 54240?
Code 54250 reports measurement of nocturnal penile tumescence and rigidity during sleep. Code 54240 is penile plethysmography, a different testing method.
Can the professional and technical portions be billed separately?
Yes. Modifier 26 identifies the professional interpretation, and modifier TC identifies the equipment and staff portion. Billing without either modifier represents the global service.
Should modifier 50 be appended?
No. The test is not billed as a bilateral service, and modifier 50 is inappropriate.
What documentation supports reporting this test?
Document the erectile dysfunction evaluation, the nocturnal monitoring performed, the recorded tumescence and rigidity findings, and the clinician’s interpretation.
How does this test differ from cavernosometry or cavernosography?
This code reports sleep-related erection monitoring. Codes 54231 and 54230 describe invasive vascular assessment methods rather than an overnight study.
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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