CPT 54200 Penile Injection Reimbursement | OpenPayer

Summary & Overview

CPT 54200: Penile Injection for Peyronie Disease

CPT code 54200 designates a penile injection procedure used to treat Peyronie disease by delivering medication into the external penis to reduce plaque-related curvature. This code matters nationally because Peyronie disease can cause pain, functional impairment, and quality-of-life effects; injectable therapies represent a common, minimally invasive management option and drive outpatient urology procedure volumes. Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will learn what CPT code 54200 represents clinically, where the service is typically provided, and how it fits into urologic outpatient care. The publication summarizes common billing contexts and expected places of service for this procedure, highlights typical modifiers and coding considerations (Data not available in the input for payer-specific rates and diagnosis mappings), and provides clinical context about why injectable therapy is used for Peyronie disease. This national overview is intended to orient clinicians, billing staff, and policy analysts to the code’s clinical role and billing classification without state-specific details.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 54200Peyronie diseasepenile injectionurologyoutpatient procedureprocedure codingclinical managementambulatory care

Billing Code Overview

CPT code 54200 describes an injection of medication into the external structures of the penis performed for treatment of Peyronie disease, a condition characterized by abnormal curvature of the erect penis. This procedure is a penile injection therapy intended to address plaque-related curvature and improve penile form and function.

Service type: Office-based or clinic procedural injection
Typical site of service: Urology clinic or outpatient ambulatory care setting

Clinical & Coding Specifications

Clinical Context

A 52-year-old man with a 1-year history of progressive penile curvature and painful erections presents to a urology clinic. He reports difficulty with sexual intercourse and localized penile plaque on exam consistent with Peyronie disease. Prior conservative management including oral therapies and observation provided inadequate symptom relief. After shared decision-making, the urologist schedules an in-office procedure to deliver intralesional medication into the tunica albuginea of the penis to reduce curvature and improve sexual function.

The clinical workflow includes pre-procedure informed consent, focused genitourinary history and physical exam, measurement and photography of curvature in the erect state (or induced pharmacologic erection), marking the injection site, local anesthesia, sterile technique, and intralesional injection of a collagenase or other approved agent directed into the plaque. The provider documents indication, laterality (if applicable), number of injections, medication and dose, anesthesia, patient tolerance, and post-procedure instructions. Typical follow-up visits assess curvature improvement, adverse events, and need for repeat injections or adjunctive modeling therapies.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure	Use when a distinct E/M visit is provided on the same day as the injection and is documented separately.

CPT 54235: Intracavernosal Pharmacologic Injection for Erectile Dysfunction

CPT-54250-NOCTURNAL-PENILE-TUMESCENCE-NPT-MONITORING

CPT 54250: Nocturnal Penile Tumescence Monitoring

CPT-54231-DYNAMIC-CAVERNOSOMETRY-WITH-PHARMACOLOGIC-INJECTION

CPT 54231: Dynamic Cavernosometry with Pharmacologic Intracavernosal Injection

CPT-54240-PENILE-PLETHYSMOGRAPHY-ERECTILE-DYSFUNCTION-ASSESSMENT

CPT 54240: Penile Plethysmography for Erectile Dysfunction Assessment

CPT-54220-IRRIGATION-OF-CORPORA-CAVERNOSA-PRIAPISM

CPT 54220: Irrigation of Corpora Cavernosa for Priapism

CPT-54205-PENILE-PLAQUE-EXPOSURE-AND-INJECTION-FOR-PEYRONIE-DISEASE

CPT 54205: Penile Plaque Exposure and Injection for Peyronie Disease

CPT-54230-CAVERNOSOGRAPHY-VENOUS-LEAKAGE-EVALUATION

CPT 54230: Cavernosography to Evaluate Venous Leakage

Taxonomy Code	Specialty	Notes
2080P0200X	Urology	Urologists most commonly perform intralesional therapy for Peyronie disease.
207K00000X	Family Medicine	Some family medicine physicians may co-manage or refer; rarely perform injections.
207R00000X	Internal Medicine	Typically involved in general care and comorbidity management; not primary proceduralists.
3336S0300X	Sexual Medicine	Providers focused on sexual medicine may perform or coordinate therapy for Peyronie disease.
208D00000X	Dermatology	Some dermatologists with procedural training may be involved in plaque-targeted injections in specialized settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N48.6`	Peyronie disease	Primary indication for intralesional injection to treat penile curvature and plaque.
`N48.89`	Other specified disorders of penis	Other localized penile disorders that may be considered in differential diagnosis or concomitant findings.
`R68.83`	Erectile dysfunction following other specified disorders	Erectile dysfunction can coexist with Peyronie disease and influence treatment decisions.
`N52.9`	Male erectile dysfunction, unspecified	Common comorbidity affecting functional outcomes and counseling for therapy.
`R07.9`	Chest pain, unspecified	Data not directly related; included for completeness.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`54100`	Repair of penis, simple; for primary closure or tuning procedures	Performed when surgical correction of penile curvature is required after or instead of intralesional therapy.
`54342`	Penile modeling procedure following intralesional injection (stretching/manipulation)	Often performed in conjunction with intralesional injections as part of a treatment protocol to improve outcomes.
`99070`	Supplies and materials provided by the physician over and above those usually included with the office visit or other services (eg, surgical trays, supplies)	Billed when additional supplies or special medication preparation are needed for the injection procedure.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, low to moderate complexity	Commonly billed on the day of or around the procedure for pre- or post-procedure evaluation when distinct from the injection service.
`J0775`	Injection, collagenase clostridium histolyticum, 0.01 mg	Drug HCPCS code used to report the specific intralesional medication when administered; billed separately from the procedure in some payor systems.

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