Summary & Overview
CPT 54405: Inflatable Penile Prosthesis, Multicomponent Implantation
CPT code 54405 represents the surgical implantation of a multicomponent inflatable penile prosthesis, including placement of cylinders, pump, and reservoir. This procedure is a definitive surgical treatment for erectile dysfunction when less invasive therapies have failed and is performed in operating rooms or ambulatory surgery centers nationwide. The code’s proper use affects inpatient and outpatient surgical billing, device procurement, and payer reimbursement policies across major national payers.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the procedure, typical sites of service, and the clinical context for use. The publication outlines common modifiers and coding considerations, payer-specific coverage patterns, and benchmarking metrics where available. It also summarizes relevant policy updates and prior-authorization trends that commonly influence use of this code.
This summary provides clinicians, coding staff, and policy analysts with the information needed to understand the clinical service represented by CPT code 54405, its role in urologic surgical care, and the payer landscape that shapes access and reimbursement nationally.
Billing Code Overview
CPT code 54405 describes the surgical insertion of an inflatable synthetic material for a multicomponent inflatable penile prosthesis. The procedure includes placement of the prosthetic cylinders into the penis, the pump (typically placed in the scrotum), and the fluid reservoir (commonly placed in the pelvis or lower abdomen).
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Service type: Surgical implantation of a multicomponent inflatable penile prosthesis
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Typical site of service: Hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A typical patient is a man with medically refractory erectile dysfunction who has failed or cannot tolerate medical (PDE-5 inhibitors) and intracavernosal therapies, or a patient with penile deformity and erectile dysfunction following radical pelvic surgery or severe pelvic trauma. The patient is evaluated in a urology clinic by a reconstructive or sexual medicine specialist. Preoperative assessment includes history and focused genitourinary exam, review of prior medical therapy, evaluation for infection risk, and counseling about device types, risks, benefits, and expected outcomes. Preoperative testing may include basic labs, urinalysis or urine culture if indicated, and cardiac clearance when relevant.
On the day of surgery, the patient is taken to an ambulatory surgery center or hospital operating room. Under general or regional anesthesia, the surgeon implants an inflatable multicomponent penile prosthesis by placing paired inflatable cylinders in the corpora cavernosa, tunneling and placing a scrotal pump, and creating a suprapubic or retropubic reservoir. Intraoperative steps include antiseptic preparation, appropriate antibiotic prophylaxis, corporal dilation, cylinder measurement and insertion, pump and reservoir placement, device testing, and layered wound closure. Postoperative workflow includes recovery monitoring, pain control, device teaching, and follow-up visits for wound check and device activation and training usually 4–6 weeks postoperatively.
Typical site of service: Ambulatory Surgery Center (ASC) or Hospital Outpatient/Operating Room.
Service type: Major operative procedure — insertion of multicomponent inflatable penile prosthesis.
Coding Specifications
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