CPT 54056
Global 010 ActiveCryosurgery penis lesion(s)
CPT 54056 Billing & Documentation Guide
CPT code 54056 (Cryosurgery 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 1.26, a non-facility practice expense RVU of 2.92, and a malpractice RVU of 0.13, a total non-facility RVU of 4.31 and facility RVU of 2.97. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $148.45, though rates vary from $128.1 to $189.68 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 54056, 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 54056 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 54056 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 54056
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.26 | 1.26 |
| Practice Expense RVU | 2.92 | 1.58 |
| Malpractice RVU | 0.13 | 0.13 |
| Total RVU | 4.31 | 2.97 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 54056
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 | $161.35 | $108.39 | $152.02 - $189.68 | 29 |
| Florida | $148.39 | $103.49 | $141.85 - $154.6 | 3 |
| Georgia | $140.39 | $97.69 | $134.26 - $146.52 | 2 |
| Illinois | $144.77 | $101.52 | $137.92 - $150.36 | 4 |
| Michigan | $139.78 | $97.75 | $136.03 - $143.52 | 2 |
| North Carolina | $135.86 | $94.1 | $135.86 - $135.86 | 1 |
| New York | $158.79 | $108.86 | $137.79 - $168.81 | 5 |
| Ohio | $135.51 | $94.64 | $135.51 - $135.51 | 1 |
| Pennsylvania | $142.64 | $98.79 | $135.72 - $149.55 | 2 |
| Texas | $142.37 | $98.3 | $134.87 - $149.2 | 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 54056
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 54056 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 54056
What does CPT code 54056 mean? +
CPT code 54056 represents: Cryosurgery penis lesion(s). It's in the Surgery (Urinary/Reproductive) category with a global period of 010.
What is the Medicare reimbursement for CPT 54056? +
The 2026 Medicare national average non-facility payment for CPT 54056 is $148.45. Rates range from $128.1 to $189.68 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 54056? +
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 54056? +
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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