Summary & Overview
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.
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
Clinical & Coding Specifications
Clinical Context
A typical patient is an otherwise healthy term newborn male or an infant presenting for a planned elective circumcision performed in the outpatient ambulatory surgery center or hospital outpatient department. The procedure is scheduled after informed consent is obtained from the parent or guardian. Preoperative assessment includes a focused history and physical exam, screening for bleeding disorders or penile anomalies (e.g., hypospadias), and review of immunizations and perinatal course. Regional anesthesia is provided with a dorsal penile nerve block or ring block; local topical anesthetic and sucrose may be used for neonates in combination. The procedure uses a clamp or device (e.g., Gomco, Plastibell) to remove the foreskin. Postoperative instructions address analgesia, wound care, signs of infection or bleeding, and follow-up. Typical documentation includes indication, consent, anesthesia technique, device used, time in/out, estimated blood loss, and disposition. Typical site of service is the ambulatory surgery center or hospital outpatient department; in some cases, it is performed in a newborn nursery or office setting when facility and payer policy permit.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Procedure furnished in part by a teaching physician | Use when a teaching physician provides some portion of the service under specific payer policies requiring this modifier. |