CPT 54411 Removal/Replacement Reimbursement | OpenPayer

Summary & Overview

CPT 54411: Removal and Replacement of Multicomponent Inflatable Penile Prosthesis

CPT code 54411 denotes the intraoperative removal and immediate replacement of the inflatable synthetic components of a multicomponent inflatable penile prosthesis. The code captures a definitive surgical revision performed in a single operative session and is relevant for urology surgical practices and facilities that manage penile prosthesis complications, device failures, or elective device upgrades. Nationally, it matters because it affects surgical case mix, device utilization, and payment policies for prosthetic urologic procedures.

Key payers commonly involved in coverage decisions for this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmarks and policy-relevant context for reimbursement coding and site-of-service considerations, as well as clinical context describing the procedure’s intent and typical surgical setting. The content highlights coding specificity required for prosthesis revision procedures, summarizes typical sites of service (hospital operating room and ambulatory surgery center), and identifies where additional clinical and billing details are required. Data not available in the input will be noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare54411CPTpenile prosthesisurology surgeryprosthesis revisionambulatory surgeryoperating roomsurgical codingdevice explantation

Billing Code Overview

CPT code 54411 describes the removal and replacement, during the same operative session, of the previously placed inflatable synthetic material of a multicomponent inflatable penile prosthesis from the penis of a patient. This service is a surgical prosthesis revision procedure involving explantation of existing inflatable components and immediate replacement with new inflatable components of a multicomponent device.

Service type: Surgical prosthesis removal and replacement (operative revision of multicomponent inflatable penile prosthesis)
Typical site of service: Hospital operating room or ambulatory surgery center (inpatient or outpatient surgical setting depending on clinical circumstances)

Clinical & Coding Specifications

Clinical Context

A 64-year-old male with a previously implanted multicomponent inflatable penile prosthesis presents with device malfunction characterized by inability to inflate the cylinders and persistent buckling during attempted use. After evaluation in the urology clinic, physical exam and device interrogation suggest mechanical failure of the penile components without evidence of active infection. The patient is scheduled for removal and replacement of the inflatable synthetic material from the penis at the same operative session. Preoperative workflow includes informed consent, preoperative medical clearance, verification of device type and manufacturer, antibiotic prophylaxis per facility protocol, and marking of prior incision sites. Intraoperative workflow includes explantation of the failed cylinders and any intracorporal components confined to the penis, inspection for fibrosis, scar management, placement of replacement inflatable cylinders (multicomponent prosthesis), hemostasis, and irrigation with antibiotic solution. Postoperative workflow includes recovery monitoring, pain control, instructions for device cycling after healing, wound care, and scheduling of follow-up with the implanting urologist for device education and activation when appropriate.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — default	Used when no specific modifier applies to the service.

CPT 54417: Removal and Replacement of Penile Prosthesis with Debridement

CPT-54390-EPISPADIAS-AND-BLADDER-EXSTROPHY-REPAIR

CPT 54390: Repair of Epispadias with Bladder Exstrophy

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

CPT 54316: Second-Stage Hypospadias Repair with Skin Graft

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

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

CPT-54416-PENILE-PROSTHESIS-REMOVAL-AND-REPLACEMENT

CPT 54416: Removal and Replacement of Penile Prosthesis

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

CPT 54328: Single-Stage Hypospadias Repair with Chordee Correction

CPT-54336-PERINEAL-HYPOSPADIAS-REPAIR-WITH-CHORDEE-CORRECTION

CPT 54336: Perineal Hypospadias Repair with Chordee Correction

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

CPT 54326: Single-Stage Hypospadias Repair with Urethral Reconstruction

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

CPT 54410: Removal and Replacement of Multicomponent Inflatable Penile Prosthesis

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

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

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Taxonomy Code	Specialty	Notes
`208000000X`	Urology	Primary specialty performing penile prosthesis removal/replacement.
`208600000X`	Female Pelvic Medicine & Reconstructive Surgery	Some reconstructive genitourinary surgeons may perform complex revisions.
`207K00000X`	Surgery — General	General surgeons with urologic training occasionally involved in complex pelvic access or complications.
`363LP0800X`	Physician Assistant	PAs commonly assist in perioperative care and follow-up.
`363A00000X`	Nurse Practitioner	NPs assist in preoperative optimization and postoperative management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N48.4`	Mechanical complication of implanted device of penis	Directly describes mechanical failure of a penile implant necessitating removal and replacement.
`T85.89XA`	Other mechanical complication of other internal prosthetic device, initial encounter	Captures mechanical complications of internal prosthetic devices when a more specific code is not used.
`T85.898A`	Other complications of genitourinary prosthetic devices, implants and grafts, initial encounter	Used for other specified complications of genitourinary prostheses presenting for treatment.
`T85.89XD`	Other mechanical complication of other internal prosthetic device, subsequent encounter	Used for follow-up encounters related to mechanical complication after initial treatment.
`N49.0`	Acute epididymitis	Infection of adjacent structures may necessitate removal rather than salvage of an implant if active infection is present.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`54411`	Removal and replacement, at the same operative session, of the previously placed inflatable synthetic material of a multicomponent inflatable penile prosthesis from the penis	Primary procedure for explantation and immediate replacement of the penile cylinders and associated penile components.
`54415`	Removal and replacement, at the same operative session, of the previously placed inflatable synthetic material, including reservoir and pump, of a multicomponent inflatable penile prosthesis	Performed when the replacement includes removal and replacement of pump and reservoir in addition to penile components.
`54416`	Removal and replacement, at the same operative session, of the previously placed inflatable synthetic material with removal and replacement of reservoir only	Performed when reservoir exchange is required in addition to penile component work.
`54300`	Implantation, inflatable penile prosthesis, 3-piece	Code for initial implantation of a multicomponent (three-piece) inflatable penile prosthesis; relevant when converting from explant to new implantation in staged cases.
`54150`	Repair of urethra, internal (urethrotomy)	May be performed if intraoperative urethral injury or stricture requires repair during prosthesis revision.

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