CPT 54110 Penile Plaque Excision Reimbursement | OpenPayer

Summary & Overview

CPT 54110: Penile Plaque Excision for Peyronie’s Disease

CPT code 54110 covers surgical excision of penile plaque or abnormal fibrous tissue to correct deformity from Peyronie’s disease, including severe curvature, painful erections, palpable shaft nodules, and penile shortening. This procedure is an important urologic intervention for patients with functional impairment or significant pain and has relevance for surgical practices, health plans, and Medicare given the potential impact on quality of life and need for specialized operative care. Key payers in national coverage discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will find clinical context on the purpose and typical settings for the procedure, benchmarks and utilization considerations where available, and summaries of common billing practices tied to this code. The publication provides a concise reference for coding teams, revenue cycle staff, and policy analysts who manage or evaluate coverage and reimbursement for surgical treatment of Peyronie’s disease. Data not available in the input is noted where relevant.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare54110CPTPeyronies diseasepenile surgeryurologysurgical procedureambulatory surgeryoperating roompenile plaque excision

Billing Code Overview

CPT code 54110 describes the excision of plaque or abnormal fibrous tissue from the penis to correct Peyronie’s disease. The procedure addresses deformities such as severe penile curvature, pain during erection, palpable lumps within the penile shaft, and shortening of the penis.

Service type: Surgical urologic procedure for correction of penile curvature and plaque excision
Typical site of service: Ambulatory surgery center or hospital operating room, performed by a urologist

Clinical & Coding Specifications

Clinical Context

A 52-year-old man with a 2-year history of progressive penile curvature and intermittent pain during erection presents for surgical management of Peyronie’s disease. Prior conservative measures (oral therapy and intralesional collagenase) produced inadequate correction and persistent functional impairment during intercourse. Examination demonstrates a dorsal plaque along the midshaft with a 60-degree curvature and mild shortening. Preoperative workup includes sexual history, objective curvature measurement, penile duplex ultrasound to assess plaque and vascular status, and counseling about risks including erectile dysfunction and penile shortening. The procedure performed is excision of the fibrous plaque in the tunica albuginea with primary repair, coded as 54110. Typical intraoperative workflow includes general or regional anesthesia, exposure of the dorsal penis, dissection to the plaque, excision of abnormal fibrous tissue, and repair with or without grafting (if grafting occurs, additional codes may apply). Postoperative care includes pain control, wound care, follow-up for wound healing, and assessment of erectile function and penile straightening. Typical site of service is an ambulatory surgery center or hospital operating room.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work, time, and intensity substantially exceed the typical service for . Documentation must justify increased resources.

CPT 54111: Excision of Penile Plaque with Skin Graft for Peyronie’s Disease

CPT-54150-CIRCUMCISION-CLAMP-DEVICE-WITH-REGIONAL-BLOCK

CPT 54150: Circumcision with Clamp or Device, Regional Penile Block

CPT-54105-PENILE-BIOPSY-DEEP-SKIN-LESION

CPT 54105: Biopsy of Penis, Deep Skin Lesion

CPT-54160-NEWBORN-CIRCUMCISION-SURGICAL-EXCISION-FORESKIN

CPT 54160: Newborn Circumcision by Excision

CPT-54164-FRENULUM-INCISION-PENIS-FRENULOTOMY

CPT 54164: Incision of Penile Frenulum to Release Glans Restriction

CPT-54162-PENILE-ADHESION-LYSIS-POST-CIRCUMCISION

CPT 54162: Lysis or Excision of Post-Circumcision Penile Adhesions

CPT-54100-PENILE-SKIN-LESION-BIOPSY-DIAGNOSTIC

CPT 54100: Biopsy of Superficial Penile Skin Lesion, Diagnostic

CPT-54120-PARTIAL-PENECTOMY-PENILE-RESECTION

CPT 54120: Partial Penectomy for Penile Injury or Disease

CPT-54135-RADICAL-PENECTOMY-BILATERAL-INGUINAL-LYMPHADENECTOMY

CPT 54135: Radical Penectomy with Bilateral Inguinal Lymphadenectomy

CPT-54125-TOTAL-PENECTOMY

CPT 54125: Total Penectomy for Serious Penile Injury or Disease

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54110

Taxonomy Code	Specialty	Notes
`155N00000X`	Urology	Primary specialty performing `54110`; surgical management of Peyronie’s disease.
`207P00000X`	Family Medicine	May refer or perform initial evaluations and conservative management prior to surgical referral.
`208800000X`	General Surgery	Occasionally involved when urologic surgeons are not available; less common.
`163W00000X`	Plastic Surgery	Performs reconstruction or grafting adjunct procedures when complex tunical reconstruction is needed.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N48.6`	Peyronie disease	Primary diagnosis indicating fibrous plaque of the penis leading to curvature and pain; direct indication for `54110`.
`N48.89`	Other specified disorders of penis	Used for atypical penile lesions or fibrous abnormalities not otherwise specified that may require excision.
`R52.2`	Chronic postprocedural pain	Relevant for documenting pain that may persist after surgery or as part of preoperative pain assessment.
`F52.21`	Male sexual dysfunction due to organic disorder	Documents erectile or other sexual dysfunction related to Peyronie’s disease when relevant to treatment planning.
`N48.1`	Phimosis	Relevant when concurrent foreskin pathology requires management in the same operative setting for access or exposure.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`54110`	Excision of plaque, or abnormal fibrous tissue, in the penis (Peyronie’s disease)	Primary procedure for surgical correction of Peyronie’s disease.
`54111`	Excision of plaque and graft; with grafting of the tunica albuginea	Used when excision requires placement of a graft to repair the tunica after plaque removal; performed as an extension of `54110` when grafting is necessary.
`54113`	Repair of penis injury, complicated (including grafts)	May be used for complex reconstructive repairs when the defect after plaque excision requires more extensive reconstruction.
`54120`	Penile implant procedures (insertion)	May be performed in patients with concurrent severe erectile dysfunction or when prosthesis is placed during reconstruction.
`54050`	Circumcision, simple; newborn or other	Performed separately if exposure or access requires circumcision prior to plaque excision in select cases.

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