CPT 54055 Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

CPT 54055: Destruction of Penile Skin Lesion

CPT code 54055 covers destruction of a penile skin lesion using high-frequency electric current for conditions such as condyloma, papilloma, molluscum contagiosum, or herpetic vesicle. This brief, targeted procedure is clinically important for lesion eradication and symptom relief and is performed across ambulatory and outpatient settings. Nationally, the code matters because it affects billing for common dermatologic and urologic office procedures and informs payer coverage and reimbursement for minor operative care.

Key payers in the discussion include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for the procedure, typical sites of service, and common billing considerations. The report outlines benchmarks and payer coverage patterns where available, summarizes relevant policy considerations and coding guidance, and highlights operative and documentation elements that drive coding accuracy. Data not provided in the input is noted as such where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 54055penile lesion destructionelectrosurgerydermatologic procedureurology procedureambulatory surgeryoutpatient procedureprocedure coding

Billing Code Overview

CPT code 54055 describes destruction of a skin lesion of the penis, such as condyloma, papilloma, molluscum contagiosum, or a herpetic vesicle, using high-frequency electric current applied locally. The procedure is performed to eradicate the lesion and relieve pain.

Service type: Destruction of dermatologic lesion on the penis using electrosurgery
Typical site of service: Ambulatory surgery center, hospital outpatient department, or office-based procedure room

Clinical & Coding Specifications

Clinical Context

A 32-year-old male presents to an outpatient urology clinic with multiple small wart-like lesions on the glans and shaft of the penis that have caused discomfort and occasional bleeding. After a focused genitourinary history and lesion-directed physical exam confirming exophytic verrucous lesions consistent with condyloma acuminata, the clinician discusses treatment options and elects lesion destruction using fulguration with high-frequency electric current in a procedure room under local anesthesia. The workflow includes informed consent, targeted topical or local infiltration anesthesia, preparation and draping of the penile skin, destruction of each lesion with electrosurgical fulguration (CPT 54055), hemostasis, and post-procedure wound care instructions. Documentation captures lesion location, size/number, technique (electrosurgical destruction), anesthesia type, estimated blood loss if any, complications, and follow-up plan. Typical sites of service are office-based procedure rooms, ambulatory surgery centers, or outpatient urology clinics. Common clinical goals are lesion eradication, symptom relief, and reduction of transmission risk.

Coding Specifications

Modifier	Description	When to Use
`11`	Professional component	Use when reporting the physician’s professional service distinct from a technical component billed by another entity.

CPT 54050: Chemical Destruction of Penile Skin Lesion

CPT-54060-PENILE-SKIN-LESION-EXCISION-DESTRUCTION

CPT 54060: Surgical Excision of Penile Skin Lesion

CPT-54057-LASER-DESTRUCTION-PENILE-SKIN-LESION

CPT 54057: Laser Destruction of Penile Skin Lesion

CPT-54056-PENILE-LESION-CRYOTHERAPY-DESTRUCTION-LIQUID-NITROGEN

CPT 54056: Destruction of Penile Skin Lesion with Liquid Nitrogen

CPT-54065-PENILE-LESION-DESTRUCTION

CPT 54065: Destruction of Extensive Penile Skin Lesions

Taxonomy Code	Specialty	Notes
207Q00000X	Urology	Urologists commonly perform penile lesion destruction in outpatient or ASC settings.
208000000X	Dermatology	Dermatologists treat cutaneous genital lesions using electrosurgery in office settings.
2086S0127X	Family Medicine	Family physicians may perform minor skin procedures including genital lesion destruction in office practice.
208D00000X	General Practice	General practitioners or primary care clinicians provide lesion destruction when scope and local practice allow.
207L00000X	Obstetrics & Gynecology	Gynecologists may treat female partners or be involved in counseling and management of genital warts; listed for completeness where genital lesion care overlaps.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`A63.0`	Anogenital (venereal) warts	Primary indication for destruction of condyloma on the penis using electrosurgical methods.
`B08.1`	Molluscum contagiosum	Viral skin infection that can present on the genitalia and be removed for symptomatic relief or diagnostic uncertainty.
`A60.9`	Anogenital herpesviral infection, unspecified	Herpetic vesicles may be treated for symptom relief or if persistent/refractory and localized destruction is indicated.
`L91.8`	Other hypertrophic disorders of skin	Used occasionally for hypertrophic or papillomatous lesions when descriptive coding is needed.
`R22.1`	Localized swelling, mass and lump, trunk	May be used when documentation describes a penile mass requiring destructive treatment (use specific codes when available).

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`54055`	Destruction of lesion(s) of the penis (e.g., condyloma, papilloma, molluscum contagiosum) by high-frequency electric current	Primary procedure for focal electrosurgical destruction of penile lesions.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Pre-procedure evaluation and decision-making visit commonly billed the same day or prior to `CPT 54055`.
`A4535`	(Not a CPT; sample supply HCPCS) Supplies for topical anesthesia	Supplies or topical anesthetic items may be used during office-based procedures (use appropriate local HCPCS codes as applicable).
`20550`	Injection(s); single tendon sheath, or ligament, or trigger point (example procedural injection code)	May be used if local infiltration anesthesia is billed separately in certain settings (check payer rules).
`99070`	Supplies and materials (except spectacles), used for patient, billed additionally	Used for non-covered consumable supplies associated with the procedure if payers allow separate supply billing.
`17000`	Destruction of benign lesions (e.g., cryotherapy or electrosurgery), up to 14 lesions	In certain settings, superficial benign lesions on other anatomic sites may be billed separately; differs by anatomic site and technique.

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