Summary & Overview
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.
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.
Data not available in the input.
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. |