How much does Medicare pay for CPT 53854?

Medicare allowed an average of $1266.82 per service and paid $999.83 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $5006.90, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 53854?

Destruction of prostate tissue using radiofrequency induced heated water vapor. It was billed 1,511 times to 1,509 Medicare beneficiaries by 81 providers in 2024.

Does 53854 pay differently in an office than a hospital?

Yes. The allowed amount averaged $1657.71 in an office setting and $639.38 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 53854 most?

Urology, with 1,350 services from 71 clinicians. Next are Ambulatory Surgical Center.

CPT 53854

Destruction of prostate tissue using radiofrequency induced heated water vapor

$1266.82Medicare-allowed amount per service, averaged across 1,511 services

Providers submitted

$5006.90

Asking price, not received

Medicare allowed

$1266.82

The fee schedule figure

Medicare paid

$999.83

Balance is patient coinsurance

Providers submitted an average of $5006.90 for this code and Medicare allowed $1266.82 — 4.0× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $999.83 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $1657.71
Hospital / facility: $639.38

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 931 services were billed in an office setting and 580 in a facility.

Services: 1,511
Beneficiaries: 1,509
Providers billing it: 81
Total allowed: $1,914,165

What Medicare pays for CPT 53854

Across 1,511 services billed by 81 providers to 1,509 beneficiaries, Medicare allowed an average of $1266.82 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 53854

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	1,350	1,348	$1257.03	71
Ambulatory Surgical Center	161	161	$1348.93	10

53854 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	191	$1471.32	$1006.57	13
Arizona	148	$1590.00	$1275.64	5
Florida	144	$1225.22	$933.55	6
Texas	100	$1455.71	$1154.07	5
Virginia	93	$884.14	$729.81	5
New York	89	$1611.00	$1077.55	5
New Jersey	86	$1605.44	$1255.85	4
Illinois	77	$1300.43	$987.84	4
Nevada	54	$1622.37	$1269.56	3
Maryland	52	$1209.55	$930.44	3
Idaho	46	$622.45	$497.78	2
South Carolina	44	$686.25	$553.67	3
Utah	41	$1110.76	$928.74	2
Colorado	40	$812.19	$617.32	2
Pennsylvania	34	$959.11	$850.25	3
Ohio	34	$685.76	$584.52	2
Iowa	28	$1485.34	$1275.62	1
Georgia	25	$1362.46	$1130.53	2
Washington	25	$1732.12	$1307.79	1
Nebraska	24	$1474.83	$1281.88	1
Oregon	23	$1571.84	$1300.85	1
West Virginia	19	$362.56	$301.01	1
New Mexico	18	$364.02	$294.97	1
District of Columbia	15	$1907.05	$1292.55	1
Massachusetts	15	$408.13	$299.27	1
Indiana	12	$1493.46	$1290.35	1
Kansas	12	$338.19	$288.98	1
Oklahoma	11	$353.82	$299.16	1
Connecticut	11	$380.20	$256.51	1

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.