Summary & Overview
CPT 54416: Removal and Replacement of Penile Prosthesis
CPT code 54416 represents the surgical removal and immediate replacement of a previously placed penile prosthesis (noninflatable semirigid or self-contained inflatable). The code captures a definitive, single-session operative service that combines explantation and reimplantation, making it clinically and financially significant for urology surgical practices and facility billing nationwide.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find national context on the code’s clinical use, typical sites of service (hospital operating room and ambulatory surgery centers), and how the service integrates into urologic operative workflows. The publication outlines typical payment considerations and benchmarking information at a national level, alongside policy-relevant topics such as coverage scope for replacement of malfunctioning or infected devices and implications for facility versus professional billing.
This summary equips billing professionals, urology clinicians, and policy analysts with a concise reference to the procedure’s definition, common settings where it is performed, and the payers commonly relevant to coverage and claims processing. Data not available in the input is noted where applicable elsewhere in the publication.
Billing Code Overview
CPT code 54416 describes the surgical removal and immediate replacement of a previously placed penile prosthesis. The procedure covers removal of a noninflatable, semirigid or a self-contained, inflatable penile prosthesis and placement of a replacement prosthesis during the same operative session.
Service type: Operative surgical procedure — prosthesis removal and replacement
Typical site of service: Hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 58-year-old male with a previously implanted inflatable penile prosthesis presents with malfunction characterized by nonfunctioning cylinders and recurrent device infection risk. After preoperative evaluation including history, focused genitourinary exam, and counseling, the patient is brought to the outpatient ambulatory surgery center (same-day) or hospital operating room. Under general or spinal anesthesia the urologist removes the existing noninflatable or inflatable components and replaces them with a new prosthesis during the same operative session, performing device explantation, debridement as needed, component sizing, reservoir and pump placement, leak testing, and device activation prior to closure. Typical workflow includes preoperative antibiotic prophylaxis, sterile field and device irrigation, intraoperative device removal and replacement, postoperative recovery with discharge instructions, and follow-up visits for wound check and device education. Typical sites of service are the ambulatory surgery center and hospital operating room.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the physician component is billed separate from technical facility services |
50 |