CPT 54055
Global 010 ActiveDestruction penis lesion(s)
CPT 54055 Billing & Documentation Guide
CPT code 54055 (Destruction penis lesion(s)) is classified under Surgery (Urinary/Reproductive) with a global period indicator of 010. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.22, a non-facility practice expense RVU of 2.81, and a malpractice RVU of 0.14, a total non-facility RVU of 4.17 and facility RVU of 2.6. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $143.54, though rates vary from $123.78 to $183.08 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 54055, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 54055 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
10-day global period (minor procedure: pre-op day + procedure + 10 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 54055 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 54055
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.22 | 1.22 |
| Practice Expense RVU | 2.81 | 1.24 |
| Malpractice RVU | 0.14 | 0.14 |
| Total RVU | 4.17 | 2.6 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 54055
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $155.8 | $93.75 | $146.81 - $183.08 | 29 |
| Florida | $144.02 | $91.41 | $137.5 - $150.28 | 3 |
| Georgia | $135.95 | $85.92 | $130.04 - $141.85 | 2 |
| Illinois | $140.52 | $89.85 | $133.75 - $146.09 | 4 |
| Michigan | $135.46 | $86.22 | $131.72 - $139.2 | 2 |
| North Carolina | $131.31 | $82.38 | $131.31 - $131.31 | 1 |
| New York | $153.74 | $95.24 | $133.2 - $163.64 | 5 |
| Ohio | $131.15 | $83.28 | $131.15 - $131.15 | 1 |
| Pennsylvania | $138.05 | $86.69 | $131.33 - $144.77 | 2 |
| Texas | $137.72 | $86.09 | $130.5 - $144.27 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 54055
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 54055 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0904T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 54055
What does CPT code 54055 mean? +
CPT code 54055 represents: Destruction penis lesion(s). It's in the Surgery (Urinary/Reproductive) category with a global period of 010.
What is the Medicare reimbursement for CPT 54055? +
The 2026 Medicare national average non-facility payment for CPT 54055 is $143.54. Rates range from $123.78 to $183.08 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 54055? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 54055? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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