CPT 54112 Penile Plaque Excision Reimbursement | OpenPayer

Summary & Overview

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

CPT code 54112 denotes excision of fibrous plaque or abnormal tissue of the penis with reconstruction using a skin graft larger than five centimeters to correct deformity from Peyronie’s disease. This urologic reconstructive procedure is clinically significant because it treats severe penile curvature, pain during erection, palpable shaft nodules, and penile shortening, all of which can have substantial quality-of-life and sexual health implications. Nationally, coverage and utilization of complex reconstructive penile procedures affect surgical access and out-of-pocket exposure for patients.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for when this surgery is performed, the typical sites of service, and the elements that define the procedure for coding purposes. The publication summarizes common modifiers and payer considerations where available, highlights benchmarks and coverage patterns when present, and summarizes relevant policy updates that may influence prior authorization and coverage determinations. The content is intended to inform billing, coding, and clinical teams about the code’s clinical intent, reporting expectations, and areas where payer policy can affect patient access and reimbursement processes.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 54112Peyronie’s diseaseUrologyPenile reconstructionSkin graftSurgical procedureOperative codingReconstructive surgeryUrologic surgery

Billing Code Overview

CPT code 54112 describes surgical excision of plaque or abnormal fibrous tissue of the penis for correction of Peyronie’s disease with closure of the defect using a skin graft greater than five centimeters in length. The procedure addresses severe penile curvature, pain with erection, palpable shaft plaques, and penile shortening related to fibrotic disease.

Service type: Surgical corrective procedure for Peyronie’s disease involving plaque excision with skin grafting (>5 cm).
Typical site of service: Operating room or ambulatory surgical center under appropriate anesthesia for urologic reconstructive surgery.

Clinical & Coding Specifications

Clinical Context

A 52-year-old man with a 2-year history of progressive penile curvature and painful erections presents after failed conservative management including oral therapy and intralesional collagenase. On physical exam a palpable fibrous plaque is identified on the dorsolateral shaft causing a 60-degree curvature and subjective penile shortening. The urologist discusses surgical correction and proceeds with excision of the plaque and placement of a split-thickness skin graft greater than 5 cm to reconstruct the tunica albuginea and restore penile length and straightness. The patient undergoes preoperative evaluation including sexual function assessment, informed consent, penile duplex ultrasound to map plaque location and vascular status, pre-op medical clearance, and anesthesia evaluation. Intraoperative steps include plaque excision, measurement of the defect, harvesting and securing a skin graft >5 cm, hemostasis, and dressing. Postoperative workflow includes pain control, wound care instructions, avoidance of sexual activity for the prescribed healing period, follow-up visits to assess graft take and erectile function, and documentation of surgical details, graft size, and any intraoperative complications for coding and billing purposes.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when intraoperative complexity or time significantly exceeds typical for plaque excision with skin graft >5 cm due to extensive dissection or reconstruction.

Related Codes

CPT-54125-TOTAL-PENECTOMY

CPT 54125: Total Penectomy for Serious Penile Injury or Disease

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

CPT 54100: Biopsy of Superficial Penile Skin Lesion, Diagnostic

CPT-54161-CIRCUMCISION-EXCISION-FORESKIN-NON-CLAMP-TECHNIQUE

CPT 54161: Excision of Foreskin (Circumcision) by Non‑Clamp Technique

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

CPT 54105: Biopsy of Penis, Deep Skin Lesion

CPT-54120-PARTIAL-PENECTOMY-PENILE-RESECTION

CPT 54120: Partial Penectomy for Penile Injury or Disease

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

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

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

CPT 54135: Radical Penectomy with Bilateral Inguinal Lymphadenectomy

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

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

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

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

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

CPT 54160: Newborn Circumcision by Excision

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Taxonomy Code	Specialty	Notes
`2080S00000X`	Urology	Primary specialty performing Peyronie’s plaque excision and grafting.
`2084P0800X`	Reconstructive Urology	Subspecialty focused on male genitourinary reconstructive procedures.
`207L00000X`	Surgery - General	General surgeons may be involved in complex soft tissue grafting in rare cases.
`2086S0123X`	Plastic Surgery	Plastic surgeons may assist or perform graft harvest and complex reconstruction.
`2084N0400X`	Male Pelvic Medicine and Reconstructive Surgery	Specialists in complex pelvic reconstructive procedures including penile reconstruction.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N48.6`	Peyronie disease	Primary diagnosis indicating fibrous plaque of the penis leading to curvature, pain, and/or shortening; direct indication for plaque excision with grafting when severe.
`N48.89`	Other specified disorders of penis	Used for atypical penile fibrous disorders when an exact code for Peyronie disease is not selected.
`N48.1`	Induration penis plastica	Synonymous or related term to Peyronie disease used in some clinical documentation; supports surgical indication.
`R68.89`	Other general symptoms and signs	Occasionally used to document nonspecific symptoms related to sexual dysfunction when combined with primary penile diagnosis (use with caution).
`F52.2`	Male erectile disorder due to physical disorder	Captures erectile dysfunction related to Peyronie disease; documents functional impact and medical justification for corrective surgery.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`54110`	Excision of plaque in the penis (eg, for Peyronie disease) without substitution of graft	Often billed when plaque excision is performed without placement of a skin graft or when defect is small and closed primarily.
`15271`	Split-thickness skin graft; trunk, arms, legs; first 100 sq cm or less, recipient site	May be used when a discrete split-thickness skin graft is harvested and reported separately for the graft component when payer policy allows separate reporting.
`15275`	Full-thickness graft, forehead, cheeks, eyelids, nose, ears, and/or neck; 20 sq cm or less	Relevant when full-thickness grafting is performed for penile reconstruction in select cases (site-specific graft CPT selection).
`54120`	Removal of penile implant	May be performed in patients with prior penile prosthesis complicating Peyronie’s repair; listed for related surgical context.
`54161`	Repair, extensive soft tissue of penis	May be used for other complex penile soft-tissue reconstructions performed in conjunction or as alternative techniques.