How much does Medicare pay for CPT 54405?

Medicare allowed an average of $3824.53 per service and paid $3042.47 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $11,665, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 54405?

Insertion of multicomponent inflatable penile implant. It was billed 2,285 times to 2,283 Medicare beneficiaries by 111 providers in 2024.

Does 54405 pay differently in an office than a hospital?

Yes. The allowed amount averaged $849.71 in an office setting and $3870.81 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 54405 most?

Urology, with 1,718 services from 86 clinicians. Next are Ambulatory Surgical Center, Physician Assistant.

CPT 54405

Insertion of multicomponent inflatable penile implant

$3824.53Medicare-allowed amount per service, averaged across 2,285 services

Providers submitted

$11,665

Asking price, not received

Medicare allowed

$3824.53

The fee schedule figure

Medicare paid

$3042.47

Balance is patient coinsurance

Providers submitted an average of $11,665 for this code and Medicare allowed $3824.53 — 3.1× 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 $3042.47 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $849.71
Hospital / facility: $3870.81

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 35 services were billed in an office setting and 2,250 in a facility.

Services: 2,285
Beneficiaries: 2,283
Providers billing it: 111
Total allowed: $8,739,051

What Medicare pays for CPT 54405

Across 2,285 services billed by 111 providers to 2,283 beneficiaries, Medicare allowed an average of $3824.53 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 54405

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	1,718	1,718	$780.17	86
Ambulatory Surgical Center	475	473	$15,556	20
Physician Assistant	92	92	$102.07	5

54405 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
Florida	344	$4850.33	$4053.47	12
Texas	224	$3076.72	$2542.80	8
California	168	$2154.33	$1559.47	10
Indiana	165	$4816.20	$3925.34	6
Tennessee	157	$6222.62	$5439.84	8
Maryland	154	$6786.90	$5536.28	9
Virginia	135	$6298.27	$5415.19	4
Arizona	94	$630.72	$490.89	4
Minnesota	82	$785.11	$616.46	3
Georgia	74	$772.95	$617.96	5
Ohio	71	$6409.32	$5559.05	4
South Carolina	59	$3294.52	$2803.29	5
New York	53	$879.28	$624.83	2
Illinois	51	$9849.11	$7662.68	2
North Carolina	50	$684.37	$577.29	3
Colorado	42	$772.06	$610.89	2
Missouri	40	$4926.69	$4023.96	3
Nevada	38	$5927.80	$4856.61	3
Arkansas	38	$7951.05	$6790.55	2
Massachusetts	34	$511.58	$398.75	2
Louisiana	33	$778.54	$620.18	2
Alabama	29	$729.43	$607.03	2
Kentucky	27	$783.19	$627.19	1
Pennsylvania	27	$799.62	$619.53	2
Nebraska	16	$716.85	$626.90	1
Oregon	15	$837.08	$625.43	1
Oklahoma	14	$748.64	$627.28	1
Mississippi	14	$784.53	$627.27	1
New Hampshire	14	$789.78	$619.60	1
Utah	12	$721.77	$606.37	1
Washington	11	$895.49	$626.40	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.