CPT Code for Multi-Component Penile Implant Insertion
The CPT code for insertion of a multi-component (inflatable) penile prosthesis is 54405. 1
CPT Code Specifications
CPT 54405 specifically designates the insertion of an inflatable penile prosthesis (IPP), which includes multi-component devices such as two-piece and three-piece inflatable systems 1, 2
CPT 54400 is used for insertion of malleable (non-inflatable) penile prostheses, which are single-component devices that maintain constant rigidity 1
CPT 54401 covers self-contained inflatable penile prostheses, which are distinct from multi-component systems 1
Insurance Coverage Considerations
Medicare Coverage
- Medicare provides coverage for inflatable penile prosthesis insertion and represents the most common insurer for this procedure, covering approximately 39.5% of patients seeking IPP placement 2
Commercial Insurance Coverage
- Among commercially insured patients seeking IPP, approximately 48% are unable to obtain coverage due to policy exclusions or claim denials, despite medical necessity 2
- Health maintenance organization (HMO) plans account for 62.6% of commercially insured patients seeking IPP, while preferred provider organization (PPO) plans represent 30% 2
Medicaid Coverage
- 28 out of 49 states with accessible fee schedules report Medicaid coverage for at least one type of penile prosthesis 1
- 24 states cover both malleable and inflatable devices, while 2 states cover only malleable prostheses and 1 state covers only inflatable devices 1
- Mean physician reimbursement for IPP placement under Medicaid is $691.76 (range: $421.68-$1,794.27), which is substantially lower than typical commercial rates 1
- Prior authorization requirements exist in 11 states, though approval criteria are often not clearly documented in fee schedules 1
Clinical Context for Coding
The procedure coded as 54405 involves implantation of multi-component systems that typically include paired cylinders placed in the corpora cavernosa, a scrotal pump mechanism, and an abdominal fluid reservoir 3, 4. This is the most commonly performed penile prosthesis design and provides the most natural appearance in both flaccid and erect states 3.