How much does Medicare pay for CPT 54235?

Medicare allowed an average of $79.66 per service and paid $60.16 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $318.12, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 54235?

Injection procedure to cause erection. It was billed 6,303 times to 5,588 Medicare beneficiaries by 258 providers in 2024.

Does 54235 pay differently in an office than a hospital?

Yes. The allowed amount averaged $84.46 in an office setting and $53.24 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 54235 most?

Urology, with 4,623 services from 180 clinicians. Next are Nurse Practitioner, Physician Assistant, Ambulatory Surgical Center.

CPT 54235

Injection procedure to cause erection

$79.66Medicare-allowed amount per service, averaged across 6,303 services

Providers submitted

$318.12

Asking price, not received

Medicare allowed

$79.66

The fee schedule figure

Medicare paid

$60.16

Balance is patient coinsurance

Providers submitted an average of $318.12 for this code and Medicare allowed $79.66 — 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 $60.16 (76%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $84.46
Hospital / facility: $53.24

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. 5,334 services were billed in an office setting and 969 in a facility.

Services: 6,303
Beneficiaries: 5,588
Providers billing it: 258
Total allowed: $502,097

What Medicare pays for CPT 54235

Across 6,303 services billed by 258 providers to 5,588 beneficiaries, Medicare allowed an average of $79.66 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 54235

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	4,623	4,034	$82.16	180
Nurse Practitioner	895	823	$72.54	38
Physician Assistant	727	680	$73.65	37
Ambulatory Surgical Center	30	30	$39.72	2
Cardiology	28	21	$93.69	1

54235 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	795	$88.56	$63.20	27
Florida	786	$86.71	$62.85	35
New York	761	$84.46	$56.27	25
Texas	761	$72.83	$54.16	29
Virginia	378	$78.89	$59.22	14
South Carolina	271	$76.04	$58.63	11
Illinois	229	$81.56	$56.50	12
Arizona	210	$76.04	$55.72	7
Massachusetts	192	$77.49	$54.88	8
Maryland	188	$95.89	$69.75	8
New Jersey	174	$94.37	$66.30	7
Missouri	149	$68.64	$50.85	4
Minnesota	140	$80.56	$60.94	4
Tennessee	138	$72.83	$57.37	7
Ohio	128	$72.84	$51.93	6
Alabama	107	$68.85	$58.81	5
Pennsylvania	103	$76.99	$55.01	4
Indiana	90	$65.06	$49.09	4
Georgia	87	$75.67	$58.24	6
Colorado	79	$63.34	$48.30	4
Michigan	58	$78.57	$56.10	3
Iowa	50	$65.48	$54.68	1
North Carolina	42	$34.04	$28.86	2
Mississippi	40	$65.42	$60.66	2
Delaware	35	$76.75	$56.88	1
Arkansas	33	$68.33	$49.05	2
Kansas	32	$59.01	$41.91	2
Connecticut	30	$70.53	$50.89	2
Kentucky	29	$70.71	$50.13	2
Montana	27	$67.59	$53.64	2
Nevada	27	$65.13	$52.08	2
Oregon	25	$69.19	$45.00	2
Wisconsin	19	$73.08	$48.47	1
New Hampshire	18	$70.51	$49.45	1
Louisiana	14	$58.51	$38.89	1
Utah	13	$49.45	$40.96	1
New Mexico	12	$72.84	$60.26	1
Nebraska	11	$69.43	$55.22	1
Rhode Island	11	$79.93	$61.15	1
Puerto Rico	11	$88.92	$64.22	1

Related codes

54200Injection procedure to correct thickened penile tissue$118.15

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.