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CPT 54401: Inflatable Penile Implant Insertion for Erectile Dysfunction

CPT code 54401 represents the surgical insertion of an inflatable penile prosthesis to treat erectile dysfunction. This procedure is a definitive, device-based therapy typically performed when conservative treatments have failed or are contraindicated. Nationally, the code is relevant for surgical urology services, implantable device coverage policies, and benefit design for sexual health and post-oncologic care.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for the implant procedure, typical sites of service, and payer coverage considerations. The publication outlines common billing and coding considerations, expected sites of care, and the role of this procedure in treatment algorithms for erectile dysfunction.

This summary provides benchmarks and policy-relevant information to help payers, providers, and administrators understand reimbursement pathways and clinical utilization drivers for device-based erectile dysfunction treatment. Data not available in the input is noted where applicable, and the material is presented for a national audience without state-specific guidance.

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Billing Code Overview

CPT code 54401 describes the surgical insertion of an inflatable synthetic device into the penis, performed to treat erectile dysfunction. The service type is a surgical implant procedure for treatment of erectile dysfunction. The typical site of service is an inpatient or outpatient surgical setting such as an ambulatory surgery center or hospital operating room, depending on clinical complexity and payer requirements.

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CPT 54401: Inflatable Penile Implant Insertion for Erectile Dysfunction

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Billing Code Overview

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Clinical & Coding Specifications

Clinical Context

A 62-year-old man with medically refractory erectile dysfunction presents to a urology clinic after failed conservative and medical therapies including phosphodiesterase-5 inhibitors and intracavernosal injections. He has stable cardiopulmonary status and has completed preoperative evaluation including cardiac clearance and informed consent for placement of an inflatable penile prosthesis. On the day of surgery the patient is admitted to an ambulatory surgery center or hospital operating room. Under general or regional anesthesia, the urologist performs a sterile operative field preparation, makes a penoscrotal or infrapubic incision, creates corporal dilations, and inserts an inflatable synthetic penile prosthesis with reservoir and pump components. Hemostasis is achieved, the incision is closed, and the patient is recovered in the PACU with postoperative instructions for wound care and device use training scheduled for follow-up visits. Typical sites of service include an ambulatory surgery center or hospital operating room. Typical service type: surgical implantation of a prosthetic device for erectile dysfunction.

Coding Specifications

Modifier	Description	When to Use
`00`	Unlisted or not a standard modifier in current CMS lists (use depends on payer)	Use only if a payer-specific numeric `00` is required by that payer — verify payer policy.
`11`	Usually indicates an initial or primary procedure (payer-specific)	Rarely used as a CMS modifier for procedures; follow payer guidance when denoting primary service.
`22`	Increased procedural services	Use when operative time or complexity substantially exceeds typical expectations due to documented increased work.
`23`	Unusual anesthesia	Use when general anesthesia is required for a procedure ordinarily performed with local/regional anesthesia and documentation supports necessity.
`26`	Professional component	Use when billing only the surgeon professional component separate from technical/hospital charges (rare for implants billed globally).
`50`	Bilateral procedure	Use when bilateral simultaneous procedures are performed and payer recognizes bilateral modifier for physician billing.
`51`	Multiple procedures	Use when additional distinct procedures are performed at the same operative session in addition to the implant.
`52`	Reduced services	Use when a procedure is partially reduced or not completed as planned with documentation of reason.
`53`	Discontinued procedure	Use when the procedure is started but discontinued due to extenuating circumstances or patient safety.
`54`	Surgical care only	Use if billing only the surgeon’s portion of care separate from pre/postoperative global services.
`55`	Postoperative management only	Use when billing only postoperative care after another provider performed the surgery.
`62`	Two surgeons	Use when two surgeons of different specialties work together as primary surgeons and documentation supports co-surgery.
`63`	Procedure performed on infants less than 4 kg	Not typically applicable; include only if patient meets criteria.
`66`	Surgical team (multiple specialists)	Use when a documented surgical team approach is billed.

Taxonomy Code	Specialty	Notes
2084P0800X	Urology	Primary specialty performing penile prosthesis implantation.
208800000X	General Surgery	May participate in complex pelvic or reconstructive cases; less common.
207RP1001X	Reproductive Endocrinology/Infertility (male reproductive specialists)	May be involved in complex sexual medicine cases.
208000000X	Family Medicine	Rarely performs; may provide pre/postoperative primary care coordination.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N52.9`	Erectile dysfunction, unspecified	Primary indication for penile prosthesis implantation when medical therapies fail.
`E29.1`	Testicular dysfunction (hypogonadism)	Can contribute to sexual dysfunction; may be present in patients considered for prosthesis.
`N48.4`	Peyronie disease	Penile curvature often coexists and may necessitate simultaneous corrective procedures during implant.
`T83.398A`	Other mechanical complication of other genitourinary device, implant and graft, initial encounter	Useful when documenting complications related to prior prosthetic devices.
`T81.89XA`	Other complications of procedures, not elsewhere classified, initial encounter	Applied for postoperative complications such as wound infection or dehiscence following implantation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`54401`	Insertion of inflatable penile prosthesis; initial placement	Primary procedure for surgical treatment of erectile dysfunction.
`54300`	Implantation of penile prosthesis, semirigid (malleable)	Alternative prosthesis type; considered when inflatable device is not used.
`54405`	Revision or removal and replacement of inflatable penile prosthesis or components	Performed for mechanical failure, infection, or malfunction after initial implant.
`54411`	Removal of inflatable penile prosthesis without replacement	Performed when explantation is required due to infection or other complications.
`54150`	Plication or corporoplasty for penile curvature (including Peyronie disease)	May be performed concurrently when penile curvature correction is needed at time of implant.

CPT 54300: Chordee Correction with Possible Urethral Mobilization

CPT-54304-CHORDEE-HYPOSPADIAS-REPAIR-STAGE-1

CPT 54304: Correction of Chordee or First-Stage Hypospadias Repair

CPT-54308-HYPOSPADIAS-SECOND-STAGE-REPAIR-DISTAL-URETHRA

CPT 54308: Second-Stage Hypospadias Repair, Distal Urethra <3 cm

CPT-54312-HYPOSPADIAS-SECOND-STAGE-URETHROPLASTY

CPT 54312: Second-Stage Hypospadias Repair with Distal Urethroplasty

CPT-54316-HYPOSPADIAS-SECOND-STAGE-REPAIR-SKIN-GRAFT

CPT 54316: Second-Stage Hypospadias Repair with Skin Graft

CPT-54318-HYPOSPADIAS-REPAIR-THIRD-STAGE-RELEASE

CPT 54318: Third-Stage Hypospadias Repair, Release of Sutures and Penile-Scrotal Release

CPT-54322-HYPOSPADIAS-MEATAL-ADVANCEMENT-V-FLAP-REPAIR

CPT 54322: Hypospadias Repair with Meatal Advancement or V-Flap

CPT-54324-HYPOSPADIAS-REPAIR-SINGLE-STAGE-URETHROPLASTY-LOCAL-FLAP

CPT 54324: Single-Stage Hypospadias Repair with Local Skin Flap

CPT-54326-HYPOSPADIAS-REPAIR-URETHROPLASTY-LOCAL-SKIN-FLAPS

CPT 54326: Single-Stage Hypospadias Repair with Urethral Reconstruction

CPT-54328-SINGLE-STAGE-HYPOSPADIAS-REPAIR-CHORDEE-CORRECTION

CPT 54328: Single-Stage Hypospadias Repair with Chordee Correction

Showing 1–10 of 34

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`00`	Unlisted or not a standard modifier in current CMS lists (use depends on payer)	Use only if a payer-specific numeric `00` is required by that payer — verify payer policy.
`11`	Usually indicates an initial or primary procedure (payer-specific)	Rarely used as a CMS modifier for procedures; follow payer guidance when denoting primary service.
`22`	Increased procedural services	Use when operative time or complexity substantially exceeds typical expectations due to documented increased work.
`23`	Unusual anesthesia	Use when general anesthesia is required for a procedure ordinarily performed with local/regional anesthesia and documentation supports necessity.
`26`	Professional component	Use when billing only the surgeon professional component separate from technical/hospital charges (rare for implants billed globally).
`50`	Bilateral procedure	Use when bilateral simultaneous procedures are performed and payer recognizes bilateral modifier for physician billing.
`51`	Multiple procedures	Use when additional distinct procedures are performed at the same operative session in addition to the implant.
`52`	Reduced services	Use when a procedure is partially reduced or not completed as planned with documentation of reason.
`53`	Discontinued procedure	Use when the procedure is started but discontinued due to extenuating circumstances or patient safety.
`54`	Surgical care only	Use if billing only the surgeon’s portion of care separate from pre/postoperative global services.
`55`	Postoperative management only	Use when billing only postoperative care after another provider performed the surgery.
`62`	Two surgeons	Use when two surgeons of different specialties work together as primary surgeons and documentation supports co-surgery.
`63`	Procedure performed on infants less than 4 kg	Not typically applicable; include only if patient meets criteria.
`66`	Surgical team (multiple specialists)	Use when a documented surgical team approach is billed.

Taxonomy Code	Specialty	Notes
2084P0800X	Urology	Primary specialty performing penile prosthesis implantation.
208800000X	General Surgery	May participate in complex pelvic or reconstructive cases; less common.
207RP1001X	Reproductive Endocrinology/Infertility (male reproductive specialists)	May be involved in complex sexual medicine cases.
208000000X	Family Medicine	Rarely performs; may provide pre/postoperative primary care coordination.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N52.9`	Erectile dysfunction, unspecified	Primary indication for penile prosthesis implantation when medical therapies fail.
`E29.1`	Testicular dysfunction (hypogonadism)	Can contribute to sexual dysfunction; may be present in patients considered for prosthesis.
`N48.4`	Peyronie disease	Penile curvature often coexists and may necessitate simultaneous corrective procedures during implant.
`T83.398A`	Other mechanical complication of other genitourinary device, implant and graft, initial encounter	Useful when documenting complications related to prior prosthetic devices.
`T81.89XA`	Other complications of procedures, not elsewhere classified, initial encounter	Applied for postoperative complications such as wound infection or dehiscence following implantation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`54401`	Insertion of inflatable penile prosthesis; initial placement	Primary procedure for surgical treatment of erectile dysfunction.
`54300`	Implantation of penile prosthesis, semirigid (malleable)	Alternative prosthesis type; considered when inflatable device is not used.
`54405`	Revision or removal and replacement of inflatable penile prosthesis or components	Performed for mechanical failure, infection, or malfunction after initial implant.
`54411`	Removal of inflatable penile prosthesis without replacement	Performed when explantation is required due to infection or other complications.
`54150`	Plication or corporoplasty for penile curvature (including Peyronie disease)	May be performed concurrently when penile curvature correction is needed at time of implant.

CPT 54300: Chordee Correction with Possible Urethral Mobilization

CPT-54304-CHORDEE-HYPOSPADIAS-REPAIR-STAGE-1

CPT 54304: Correction of Chordee or First-Stage Hypospadias Repair

CPT-54308-HYPOSPADIAS-SECOND-STAGE-REPAIR-DISTAL-URETHRA

CPT 54308: Second-Stage Hypospadias Repair, Distal Urethra <3 cm

CPT-54312-HYPOSPADIAS-SECOND-STAGE-URETHROPLASTY

CPT 54312: Second-Stage Hypospadias Repair with Distal Urethroplasty

CPT-54316-HYPOSPADIAS-SECOND-STAGE-REPAIR-SKIN-GRAFT

CPT 54316: Second-Stage Hypospadias Repair with Skin Graft

CPT-54318-HYPOSPADIAS-REPAIR-THIRD-STAGE-RELEASE

CPT 54318: Third-Stage Hypospadias Repair, Release of Sutures and Penile-Scrotal Release

CPT-54322-HYPOSPADIAS-MEATAL-ADVANCEMENT-V-FLAP-REPAIR

CPT 54322: Hypospadias Repair with Meatal Advancement or V-Flap

CPT-54324-HYPOSPADIAS-REPAIR-SINGLE-STAGE-URETHROPLASTY-LOCAL-FLAP

CPT 54324: Single-Stage Hypospadias Repair with Local Skin Flap

CPT-54326-HYPOSPADIAS-REPAIR-URETHROPLASTY-LOCAL-SKIN-FLAPS

CPT 54326: Single-Stage Hypospadias Repair with Urethral Reconstruction

CPT-54328-SINGLE-STAGE-HYPOSPADIAS-REPAIR-CHORDEE-CORRECTION

CPT 54328: Single-Stage Hypospadias Repair with Chordee Correction

Showing 1–10 of 34

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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CPT 54401: Inflatable Penile Implant Insertion for Erectile Dysfunction

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Billing Code Overview

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CPT 54401: Inflatable Penile Implant Insertion for Erectile Dysfunction

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

CPT 54401: Inflatable Penile Implant Insertion for Erectile Dysfunction

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Billing Code Overview

CPT 54401: Inflatable Penile Implant Insertion for Erectile Dysfunction

Sign up for cpt 54401 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 54401 represent and where is it typically performed?

What are common related CPT codes and when are they used?

Which modifiers are listed as relevant for CPT 54401 and how should they be applied?

Which medical specialties typically perform this procedure?

What ICD-10 diagnosis codes are commonly associated with CPT 54401?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 54401 represent and where is it typically performed?

What are common related CPT codes and when are they used?

Which modifiers are listed as relevant for CPT 54401 and how should they be applied?

Which medical specialties typically perform this procedure?

What ICD-10 diagnosis codes are commonly associated with CPT 54401?

References