CPT 54406 Inflatable Penile Prosthesis Reimbursement | OpenPayer

Summary & Overview

CPT 54406: Removal of Inflatable Penile Prosthesis

CPT code 54406 documents surgical removal of a previously implanted multicomponent inflatable penile prosthesis, including explantation of the pump, cylinders, and reservoir, without replacement. This code matters nationally as it captures definitive surgical management for device-related complications, infection, malfunction, or patient choice, and it affects hospital and ambulatory surgery billing patterns as well as device utilization metrics. Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical service represented by the code, typical sites of service, and which payers commonly cover such procedures. The publication also summarizes benchmarking considerations, common modifiers encountered in claims, and relevant policy implications that influence coverage and reimbursement. The material is intended to help coding professionals, revenue cycle staff, and policy analysts understand where CPT code 54406 fits within surgical urology coding, how it is reported when a prosthesis is removed without replacement, and what documentation and claim elements are typically relevant. Data not available in the input for payor-specific rates, detailed ICD-10 pairings, and associated taxonomy codes is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare54406CPTurologypenile-prosthesisexplantationsurgical-procedureambulatory-surgerydevice-removal

Billing Code Overview

CPT code 54406 describes the surgical removal of a previously placed multicomponent, inflatable penile prosthesis. The procedure includes removal of the inflatable synthetic material from the penis as well as explantation of the pump, cylinders, and reservoir. The description specifies that this service does not represent replacement of the prosthesis.

Service type: Surgical explantation of a multicomponent inflatable penile prosthesis
Typical site of service: Operating room or ambulatory surgical center, with inpatient setting possible depending on clinical condition and perioperative needs

Data not available in the input for Associated Taxonomies, ICD-10 Diagnoses, and Related Codes.

Clinical & Coding Specifications

Clinical Context

A 68-year-old male with a previously implanted multicomponent inflatable penile prosthesis presents with chronic device malfunction and recurrent infection localized to the pump and cylinder components. After preoperative evaluation including history, focused genitourinary exam, and perioperative counseling, the patient is taken to the operating room for removal of the entire inflatable prosthesis system. Under general or regional anesthesia, the surgeon makes existing incision(s), evacuates any purulent material if present, disconnects and removes the pump from the scrotum, withdraws both penile cylinders, and retrieves the fluid reservoir from the retropubic or preperitoneal space. The procedure documented is explantation only and does not include replacement or immediate reimplantation. Typical perioperative workflow includes preoperative antibiotic administration, intraoperative cultures if infection is suspected, hemostasis, possible placement of drains, wound closure, and post-anesthesia recovery. Typical postoperative management includes wound care, antibiotics as indicated, pain control, and follow-up for wound check and counseling regarding future prosthesis options.

Coding Specifications

Modifier	Description	When to Use
`52`	Reduced Services	Use when the explantation is partially performed or procedure is abbreviated.

CPT 54328: Single-Stage Hypospadias Repair with Chordee Correction

CPT-54435-PENILE-SHUNT-PROCEDURE-PRIAPISM

CPT 54435: Penile Shunt Procedure for Priapism

CPT-54405-INFLATABLE-PENILE-PROSTHESIS-IMPLANTATION-MULTICOMPONENT

CPT 54405: Inflatable Penile Prosthesis, Multicomponent Implantation

CPT-54430-CORPORA-SHUNT-FOR-PRIAPISM-RELIEF

CPT 54430: Corporal-Cavernosal/Spongiosal Shunt for Priapism

CPT-54348-HYPOSPADIAS-COMPLICATION-REPAIR-URETHROPLASTY

CPT 54348: Repair of Complications After Hypospadias Surgery

CPT-54410-PENILE-PROSTHESIS-EXPLANT-AND-REPLACEMENT

CPT 54410: Removal and Replacement of Multicomponent Inflatable Penile Prosthesis

CPT-54312-HYPOSPADIAS-SECOND-STAGE-URETHROPLASTY

CPT 54312: Second-Stage Hypospadias Repair with Distal Urethroplasty

CPT-54360-PENILE-ANGULATION-REPAIR

CPT 54360: Surgical Repair of Penile Angulation

CPT-54400-SEMIRIGID-PENILE-PROSTHESIS-INSERTION

CPT 54400: Semirigid Penile Prosthesis Insertion

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

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

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Taxonomy Code	Specialty	Notes
`206E00000X`	Urology	Urologists most commonly perform device explantation.
`207L00000X`	General Surgery	Some general surgeons with relevant experience may perform explantation in complex cases.
`103K00000X`	Anesthesiology	Anesthesiologists provide general or regional anesthesia during the procedure.
`363A00000X`	Infectious Disease	Infectious disease specialists may be involved in perioperative management for infected devices.
`207P00000X`	Surgical Oncology	Rarely involved if concurrent oncologic surgery or radiation-related complications are present.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`T83.318A`	Breakdown (mechanical) of other internal prosthetic devices, implants and grafts, initial encounter	Applicable for mechanical failure of an inflatable penile prosthesis requiring removal.
`T83.319A`	Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts, initial encounter	Applicable for infected penile prosthesis necessitating explantation.
`N48.89`	Other specified disorders of penis	Used for non-specific penile complications related to prosthesis that lead to removal.
`N48.4`	Penile deformity (eg, Peyronie disease)	May be relevant if deformity or device-related complications lead to removal.
`A49.9`	Bacterial infection, unspecified	Used when a specific infectious organism is not yet identified but infection prompts explantation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`54400`	Removal of inflatable penile prosthesis, including pump, cylinders, and reservoir; simple removal	May be used for explantation when documentation supports a simpler or different technique; code selection depends on operative details.
`54401`	Removal of inflatable penile prosthesis, including pump, cylinders, and reservoir; removal with replacement of pump or components	Used when partial removal is followed by replacement of one or more components (not applicable if no replacement occurs).
`54300`	Repair of inflatable penile prosthesis (eg, pump, cylinders)	Relevant if intraoperative decision shifts to repair rather than full explantation; documents alternative management.
`54150`	Penile prosthesis, insertion of multi-component, inflatable	Represents the initial implantation procedure often performed earlier in the patient’s history; relevant for longitudinal coding and documentation.
`11042`	Debridement; skin, subcutaneous tissue and muscle, first stage	May be billed if extensive debridement of infected or necrotic tissue is performed at the time of explantation.