CPT 54111 Excision Plaque Skin Graft Reimbursement | OpenPayer

Summary & Overview

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

CPT code 54111 covers surgical excision of penile plaque or abnormal fibrous tissue with closure using a skin graft up to five centimeters, a procedure used to treat Peyronie’s disease. Nationally, this code captures definitive surgical management for patients experiencing significant penile curvature, pain during erection, palpable shaft lumps, or penile shortening that are refractory to conservative therapy. Because Peyronie’s disease can significantly affect quality of life and sexual function, accurate coding for reconstructive procedures matters for clinical tracking, access to specialty surgical care, and payment policy.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides readers with clinical context for when the procedure is performed, typical sites of service (ambulatory surgery centers and hospital operating rooms), and the coding specifics clinicians and billing teams need to document this reconstructive surgery. Readers will find benchmarks and payer coverage summaries where available, discussion of documentation elements required to support medical necessity, and summaries of common billing considerations. Data not available in the input are noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 54111Peyronies disease surgerypenile plaque excisionskin graftingurologyreconstructive surgeryambulatory surgeryoperative proceduresurgical coding

Billing Code Overview

CPT code 54111 describes excision of plaque or abnormal fibrous tissue from the penis with closure using a skin graft up to five centimeters in length. This surgical procedure is performed to correct Peyronie’s disease, which can cause severe penile curvature, pain with erection, palpable lumps within the shaft, and penile shortening.

Service type: Surgical excision with skin grafting for correction of Peyronie’s disease
Typical site of service: Ambulatory surgery center or hospital operating room

Clinical & Coding Specifications

Clinical Context

A 52-year-old male with a two-year history of progressive penile curvature and painful erections presents after failed conservative management (oral therapy and intralesional injections). Physical exam identifies a palpable dorsal plaque with 40-degree curvature causing sexual dysfunction and shortening. The urologist schedules operative correction: excision of the fibrous plaque with placement of a skin graft up to 5 cm in length (CPT 54111). The clinical workflow includes preoperative counseling and consent, pre-op clearance and labs, marking and photographs of curvature, anesthesia evaluation (typically general or regional), intraoperative plaque excision and measurement of the defect, harvest and placement of skin graft (usually from the thigh), meticulous closure and dressing, immediate post-anesthesia recovery, postoperative pain control, wound care instructions, and scheduled follow-up visits for graft assessment, erectile rehabilitation planning, and sexual function counseling. Typical site of service is an ambulatory surgical center or hospital outpatient surgical suite. The service type is reconstructive urologic surgery for correction of Peyronie’s disease.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work, time, or complexity substantially exceeds typical for `CPT 54111` (document specifics).

CPT 54135: Radical Penectomy with Bilateral Inguinal Lymphadenectomy

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

CPT 54105: Biopsy of Penis, Deep Skin Lesion

CPT-54163-EXCISION-RESIDUAL-FORESKIN-POST-CIRCUMCISION

CPT 54163: Excision of Residual Foreskin After Prior Circumcision

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

CPT 54160: Newborn Circumcision by Excision

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

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

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

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

CPT-54120-PARTIAL-PENECTOMY-PENILE-RESECTION

CPT 54120: Partial Penectomy for Penile Injury or Disease

CPT-54112-PENILE-PLA QUE-EXCISION-SKIN-GRAFT

CPT 54112: Excision of Penile Plaque with Skin Graft >5 cm

CPT-54115-PENILE-IMPLANT-OR-DEEP-PENILE-FOREIGN-BODY-REMOVAL

CPT 54115: Removal of Penile Implant or Deep Penile Foreign Body

CPT-54164-FRENULUM-INCISION-PENIS-FRENULOTOMY

CPT 54164: Incision of Penile Frenulum to Release Glans Restriction

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Taxonomy Code	Specialty	Notes
208000000X	Urology	Primary specialty performing penile reconstructive surgery for Peyronie’s disease.
2084P0800X	Male Reproductive Urology	Subspecialty focusing on penile reconstructive and functional procedures.
207E00000X	General Surgery	Occasionally involved when graft harvest or complex reconstruction requires general surgeons (rare).
363L00000X	Plastic Surgery	May perform skin graft harvest/placement in collaboration on complex defects.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N48.6`	Peyronie disease	Primary diagnosis indicating fibrous plaque of the penis causing curvature and pain; direct indication for `CPT 54111`.
`N48.89`	Other specified disorders of penis	Used when other penile fibrotic or structural abnormalities not otherwise classified contribute to operative repair.
`N48.4`	Phimosis	May be relevant when concomitant procedures such as circumcision are required for exposure or graft placement.
`R68.83`	Penile shortening	Symptom code reflecting patient-reported shortening related to Peyronie’s disease and may support reconstructive intervention.
`N50.8`	Other specified disorders of male genital organs	Broad code for associated penile pathology considered during surgical planning when specifics differ.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`54111`	Excision of plaque or abnormal fibrous tissue and closure with skin graft, up to 5 cm; for Peyronie’s disease	Primary procedure described — plaque excision with skin grafting to correct penile curvature and restore length/shape.
`15260`	Full-thickness skin graft, finger/toe, single or multiple; up to 5 cm	Common skin graft technique code for small grafts; used when billing graft harvesting separate from primary code if payer requires.
`15271`	Skin graft, intermediate or large, trunk, arms, legs; 20 sq cm or less, first stage, includes donor site	Alternative graft code when larger or different graft site required (billing depends on payer rules).
`54120`	Corporoplasty (eg, Nesbit procedure), with or without incision and patch graft	Related reconstructive penile procedures for curvature correction; may be performed instead of or in combination with grafting depending on anatomy.
`54300`	Circumcision, surgical excision other than neonatal; simple	May be performed concurrently if prep or exposure requires and documented as separate medical need.
`99024`	Postoperative follow-up visit global period	Used to bill separate postoperative visits when payer allows outside the global period; documents follow-up care after `CPT 54111`.

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