Summary & Overview
CPT 54400: Semirigid Penile Prosthesis Insertion
CPT code 54400 denotes the surgical insertion of a semirigid, noninflatable synthetic penile prosthesis for the treatment of erectile dysfunction. This procedure is clinically significant as a durable therapeutic option for patients with refractory erectile dysfunction when conservative medical therapies are ineffective. Nationally, the code captures a distinct urologic surgical service with implications for surgical resource use, device supply, and postoperative care.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context, typical sites of service, and payer coverage considerations. The publication covers benchmarking and utilization perspectives, coding and billing considerations relevant to surgical device implantation, and the clinical circumstances that commonly lead to selection of a semirigid implant.
The content offers practical reference material for coding and revenue cycle teams, clinical program managers, and policy analysts seeking clarity on the procedure represented by CPT code 54400. It outlines what to expect for service delivery settings and highlights areas where payers and Medicare policies commonly influence authorization and reimbursement processes. Data not available in the input will be noted where specific payer policy details or diagnosis mappings would otherwise appear.
Billing Code Overview
CPT code 54400 describes the insertion of a semirigid noninflatable synthetic penile prosthesis to treat erectile dysfunction. The procedure involves placing a surgically implanted semirigid rod into the penis to provide rigidity for sexual intercourse.
Service type: Surgical penile prosthesis implantation
Typical site of service: Hospital operating room or ambulatory surgery center
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 62-year-old male with a multi-year history of medically refractory erectile dysfunction presents after failure of oral phosphodiesterase-5 inhibitors and intracavernosal injection therapy. He has stable cardiovascular status after cardiology clearance and desires a permanent solution. The urologist schedules implantation of a semirigid noninflatable penile prosthesis (CPT 54400) in an ambulatory surgery center. Preoperative workflow includes history and physical, informed consent discussing device characteristics and risks (infection, device erosion, pain), preoperative antibiotics per facility protocol, and marking of operative site. Intraoperative steps include general or regional anesthesia, antiseptic prep, a penoscrotal or infrapubic incision, corporotomy, dilation of the corporal bodies, insertion and seating of the semirigid rods, trimming and closure, and sterile dressing. Postoperative workflow includes recovery monitoring, pain control, wound care instructions, limitation of sexual activity for healing, and follow-up visits to evaluate healing and device function. Typical site of service: ambulatory surgery center or hospital outpatient department. Service type: surgical implant procedure for erectile dysfunction management.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/No modifier | Applied when no specific modifier applies |