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CPT 54150: Circumcision with Clamp or Device, Regional Penile Block
CPT code 54150 denotes a circumcision performed with a clamp or similar device under regional anesthesia (dorsal penile or ring block). This minor urologic surgical code captures a common procedure across pediatric and adult patient populations and has implications for surgical practices, billing workflows, and payer coverage policies nationwide. Clear coding for 54150 ensures accurate claims, appropriate anesthesia reporting, and alignment with payer medical necessity rules.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise national overview of the code's clinical context, the typical sites of service where the procedure is performed, and the payer landscape that affects reimbursement and prior authorization practices. The publication also outlines common billing modifiers and reporting considerations, operational benchmarks for service lines performing minor urologic procedures, and policy-related updates that influence coverage decisions.
This summary is intended for clinicians, billing professionals, and policy analysts who need a clear, practical reference to CPT code 54150, its clinical application, and the payer environment that shapes its use in practice.
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Billing Code Overview
CPT code 54150 describes a circumcision procedure in which the provider removes the foreskin of the penis using a clamp or other device. The procedure is performed with regional anesthesia, specifically a dorsal penile or ring block, as noted in the code description.
Service type: Surgical procedure — minor urologic surgery
Typical site of service: Outpatient surgical suite, ambulatory surgery center, or physician office procedure room
National Reimbursement Benchmarks
Medicare average reimbursement for CPT 54150 sits near $156, while BUCA’s mean commercial rate is substantially higher at $1,364.60, reflecting that BUCA commercial arrangements tend to pay multiples of Medicare for this code. The gap between Medicare and BUCA underscores broad differences between federal fee schedules and some commercial networks’ negotiated totals.
Dispersion measured by the interquartile range (P75–P25) varies widely across payers: Blue Cross Blue Shield shows the largest spread at $3,113.00 (P75 $3,515.90 minus P25 $420.20), indicating high variability in negotiated rates, while Aetna is among the tightest with a range of $124.50 (P75 $182.10 minus P25 $59.60). UnitedHealth Group and Cigna have intermediate spreads of $154.40 and $136.10 respectively, and BUCA’s interquartile range is $1,828.00.