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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.
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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
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