CPT 54115 Penile Implant Removal Reimbursement | OpenPayer

Summary & Overview

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

CPT code 54115 covers surgical removal of a penile implant or any foreign body lodged in the deep tissues of the penis. Nationally, this code represents a specialized urologic surgical service often performed in hospital operating rooms or ambulatory surgical centers when device complications, infection, mechanical failure, or other adverse events require explantation. The code matters because it captures resource-intensive, specialty surgical care with implications for surgical scheduling, device tracking, and postoperative management.

Key payers commonly involved in coverage for this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of clinical context, expected site-of-service settings, and the role of this code in coding workflows. The publication provides benchmarks and policy-relevant context where available, highlights common billing modifiers and use cases, and summarizes considerations for claims submission and payer adjudication. Data not available in the input is noted and not inferred.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 54115penile implant removalurology surgeryexplantationambulatory surgical centeroperating roomsurgical billingdevice explant

Billing Code Overview

CPT code 54115 describes the surgical removal of a penile implant or any other foreign body from the deep tissues of the penis. This procedure involves extraction of implanted or embedded devices or foreign material located within the corporal bodies or deeper penile tissues.

Service type: Surgical explantation of deep penile foreign body
Typical site of service: Hospital operating room or ambulatory surgical center

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult male with a history of a previously placed inflatable or malleable penile prosthesis who presents with device malfunction, infection, extrusion, or chronic pain requiring explantation. The clinical workflow begins with preoperative evaluation including history, focused genitourinary exam, laboratory testing (CBC, basic metabolic panel, urinalysis), and penile/prosthesis imaging as indicated. When infection is suspected, antibiotics are administered and device removal is scheduled; in noninfectious malfunction cases, elective removal is planned with counseling about potential future revision or reconstruction. In the operating room under general or regional anesthesia, the urologist performs removal of the implanted device and any foreign material from deep tissues of the penis, achieves hemostasis, irrigates and cultures if infection is present, and closes wounds; drainage or delayed closure may be used for infected cases. Postoperative care includes pain control, wound care, tailored antibiotics if infection confirmed, and follow-up for wound healing and discussion of potential reimplantation or alternative therapies.

Coding Specifications

Modifier	Description	When to Use
`52`	Reduced services	Use when a portion of the procedure is intentionally not completed or only partial removal is performed.

CPT 54130: Total Penectomy with Inguinal Lymphadenectomy

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

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

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

CPT 54105: Biopsy of Penis, Deep Skin Lesion

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-54110-PENILE-PLAQUE-EXCISION-PEYRONIES-DISEASE

CPT 54110: Penile Plaque Excision for Peyronie’s Disease

CPT-54120-PARTIAL-PENECTOMY-PENILE-RESECTION

CPT 54120: Partial Penectomy for Penile Injury or Disease

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

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

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

CPT 54135: Radical Penectomy with Bilateral Inguinal Lymphadenectomy

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

CPT 54163: Excision of Residual Foreskin After Prior Circumcision

Showing 1–10 of 15

53

Taxonomy Code	Specialty	Notes
208800000X	Urology	Primary specialty performing penile implant removal and deep tissue explantation.
208D00000X	General Surgery	May be involved for complex pelvic or perineal wounds or reconstructive needs.
207LN0300X	Plastic Surgery	Involved when significant penile or scrotal reconstruction is required after explantation.
207RH0000X	Infectious Disease	Consult for complex prosthesis infections and prolonged antimicrobial therapy.
2080S0122X	Wound Care/Hyperbaric Medicine	Consult for nonhealing wounds or adjunctive therapies post-explantation.

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`54110`	Removal of penile implant, simple, through original incision	Used for removal of prosthesis components when extraction is straightforward and limited to accessible portions.
`54112`	Removal of penile implant reservoir and pump	Used when separate components (pump/reservoir) require removal in addition to intracorporeal components.
`54113`	Removal of penile implant with extensive scar tissue dissection	Used when dense fibrosis requires more extensive dissection than routine explantation.
`11042`	Debridement, subcutaneous tissue, first 20 sq cm or less	May be used when debridement of infected subcutaneous tissue of the penis is required during explant.
`87070`	Culture, bacterial; any other source except blood, aerobic and anaerobic isolation and presumptive identification	Used when intraoperative cultures are obtained from the prosthesis or deep tissue to guide antibiotic therapy.
`20680`	Removal of implant; deep (e.g., buried cortical bone fixation device)	Analogous to deep implant removal codes when deeper hardware or foreign body removal is required (use clinical correlation and payer guidelines).

OpenPayer