Summary & Overview
CPT 54130: Total Penectomy with Inguinal Lymphadenectomy
CPT code 54130 denotes a total penectomy with regional inguinal lymph node dissection, an extensive oncologic operation used for advanced or treatment-refractory penile cancer. Nationally, this code represents a low-volume but high-acuity surgical service with significant implications for inpatient surgical capacity, perioperative quality measures, and long-term survivorship care.
Key payers in typical analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical description, expected site-of-service patterns, and a framework for interpreting utilization and coverage considerations for major oncologic genitourinary surgeries.
The publication summarizes benchmarks for utilization and reimbursement where available, highlights relevant clinical context for case selection and expected care pathways, and identifies common policy levers that payers use to manage access and authorization for high-cost, high-complexity inpatient procedures. Data not available in the input will be noted as such in the detailed sections.
Billing Code Overview
CPT code 54130 describes a surgical procedure in which the provider performs a total penectomy with removal of regional inguinal lymph nodes. The procedure is performed to treat penile cancer that is unresponsive to standard therapies or when the tumor is large or deeply invasive.
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Service type: Major extirpative oncologic surgery
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Typical site of service: Inpatient hospital surgical setting, often in an operating room with postoperative inpatient care
Clinical & Coding Specifications
Clinical Context
A typical patient is a male in his 50s–70s presenting with an ulcerative or exophytic penile mass with progressive growth, bleeding, pain, and/or fixed inguinal lymphadenopathy. Prior management often includes biopsy confirming invasive squamous cell carcinoma and staging imaging (CT or PET/CT) demonstrating extensive primary tumor involving the penile shaft and possible regional nodal metastases. Multidisciplinary evaluation (urology, medical oncology, radiation oncology) determines that organ‑preserving surgery or partial penectomy is not feasible due to tumor size, multifocality, or depth of invasion; or the disease is recurrent after prior therapy.
The clinical workflow includes preoperative staging and optimization, informed consent discussing radical penectomy with bilateral inguinal lymphadenectomy, marking of incision lines, general anesthesia, intraoperative removal of the entire penis and relevant superficial and deep inguinal lymph nodes, hemostasis and reconstruction or perineal urethrostomy when indicated, placement of drains, and postoperative monitoring for wound complications, lymphatic drainage issues, and urinary function. Pathology confirms margins and nodal status, guiding adjuvant therapy decisions such as radiation or systemic therapy. Typical site of service is an inpatient surgical setting at an acute care hospital; the service type is major operative oncology surgery for penile cancer.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Provider part of coordinated team (standard) |