Circumcision CPT code(s) 54150-54163 are used to report services when the physician performs circumcision procedures. Circumcision is the removal of extra or foreskin from the penis.
Circumcision CPT Code Description
Circumcision CPT code has numerous benefits to individuals or babies, such as reducing the risks of UTI, STD, HIV Cervical and penile cancer. There are the following steps usually performed by the physician while doing circumcising:
Local or general anesthesia is administrated to the targeted sites.
Removal of the foreskin, with or without using clamps or other devices, and trimming the extra skin around the penis.
The penis sides or segments of the foreskin are being crushed with forceps.
The scissors are used to make incisions on the crushed part and extract skin from the head of the penis.
Chemical cautery or suture ligatures control the bleeding during the Circumcision procedure.
The physician creates the skin edges and then sutured with absorbable suture material.
Circumcision revision (repair) aids in retraction of the foreskin, like cleansing glans and post-circumcision adhesions. If any fibrous rings are detected, physicians will perform two vertical incisions, and transversely running fibrous bands are divided to expose the underlying Bucks’ fascia. After that, these skin edges will be closed with interrupted sutures.
There are services usually performed with anesthesia and normally performed on infants after birth and in some cases on adults as well.
There are separate CPT codes to describe a patient’s age, such as age is less than or 28 days (about four weeks) or Greater than 28 days (about four weeks).
There are various aspects of this procedure, such as religious, cultural, and medical reasons. There are different methods and techniques used to perform the circumcision procedure (54150-54163), which are as follows:
If circumcision is performed using clamps or other devices with ring block or Regional dorsal penile, then CPT 54150 will be reported.
If circumcision is performed with simple surgical excision without any aid of device and clamp, it would be reported with CPT codes 54160 or 54161. These CPT codes 54160 or 54161 would be based on the age of the patients.
Suppose the circumcision procedure is repeated or repaired or any post circumcision complication develops like the patient and needs another procedure for corrections or complications of prior circumcision. In that case, it is appropriate to report with CPT codes 54162 or 54163, or both.
Suppose the surgical procedure is done to just remove the membrane (frenulum) that attaches the foreskin to the penis, and this procedure is known as Frenulotomy. In that case, it will not be reported with Circumcision procedure codes (54150-54163).
Circumcision CPT code procedures are reported with 54150-54163 and descriptions are as follows:
CPT 54150: Circumcision reported with CPT 54150 when it is performed by using a clamp with ring block or regional dorsal penile
CPT 54160: Circumcision reported with CPT 54160 when performed by surgical excision without clamp, device, or dorsal slit on neonate (28 days (about four weeks) of age or less).
CPT 54161: Circumcision reported with CPT 54161 when performed by surgical excision without clamp, device, or dorsal slit (older than 28 days (about four weeks) of age).
CPT 54162: It will be reported for lysis or excision of penile post-circumcision adhesions
CPT 54163: It will be reported for the repair of incomplete circumcision
Circumcision CPT Code Billing Guidelines
If circumcision procedure is performed without a dorsal penile block or a ring block, then it is appropriate to attach modifier 52 with CPT 54150.
Modifier 63 will not be reported with CPT codes 54150 or 54160 because it includes this group or age of infants who are less than 28 days (about four weeks) or 28 days (about four weeks) up to 4 kg due to the nature of the procedure.
The CPT codes (54150-54163) require the medical necessity to support this procedure. Therefore, Check your payer guidelines of insurances coverage for reimbursement purposes. The patient may be responsible for the charges.
These CPT codes (54150-54163) do not include any dilation or manipulation and would not be reported separately.
Circumcision CPT codes (54150-54163) include local or general anesthesia for the circumcision procedure, and it would not be reported separately.
If any surgical repair is reported for the post-circumcision procedure, it would be reported with CPT codes 54163 and for lysis or excision of post-circumcision adhesions reports with CPT 54162.
These procedures (54162 and 54163) can be performed together on the same service date with the appropriate modifier. The modifier is applicable with CPT 54162 according to NCCI (National Correct Coding Initiative).
CPT 54164 (Frenulotomy of the penis) is separately reportable in combination with CPT codes (54150-54163) on the same service date. The modifier is applicable with CPT 54164 according to NCCI.
The following is a list of modifiers that are applicable with CPT codes (54150-54163):
- 47, 50, 51, 52, 53, 55, 54, 23, 22, 47, 50, 51, 52, 53, 55, 54, 56, 58, 59, 63, 76, 77, 78, 79, 99, AI, AQ, AR, CC, CR, EY, ET, GA, GC, GJ, GK, GR, GU, GY, GZ, KX, LT, PT, QJ, Q5, Q6, RT, SG, XE, XP, XU, XS.
Modifier 52 is applicable with CPT 54150 when circumcision is performed without dorsal penile or ring block or if service was reduced than usual due to some unavoidable circumstances.
Modifier 47 will be appended with C CPT codes (54150-54163) if anesthesia is given by an assistant or attending surgeon.
Modifier 59 is applicable with CPT codes (54150-54163) if any other procedure is done in combination with these services that are not normally billed together on the same date of service, then modifier 59 will be appropriate while modifier 51 is applicable when the other procedure is not the component of CPT codes (54150-54163).
Modifier 23 is applicable with CPT codes (54150-54163) if general or local anesthesia is given to patients who are normally not required for the procedure.
Modifier 76 will be attached to Circumcision CPT code (54150-54163) if service is repeated by the same physician on the same date of service, while modifier 77 if the procedure has been done on the same date service a different physician, respectively.
Modifier 78 will be appended with CPT codes (54160-54163) if the procedure is repeated with the same condition of the global period. In contrast, modifier 79 is applicable when the procedure is reported for an unrelated condition.
Circumcision CPT Code Reimbursement
The cost and RUVS of Circumcision CPTs are as follows:
CPT 54150 (Facility Price: COST $103.51 RUVS 2.99120) (Non-Facility Price: COST $167.76 RUVS 4.84770)
CPT 54160 (Facility Price: COST $157.50 RUVS 4.55122) (Non-Facility Price: COST $250.21 RUVS 7.23022)
CPT 54161 (Facility Price: COST $214.65 RUVS 6.20266) (Non-Facility Price: COST $214.65 RUVS 6.20266)
CPT 54162 (Facility Price: COST $218.31 RUVS 6.30841) (Non-Facility Price: $290.28 COST RUVS 8.38816)
CPT 54163 (Facility Price: COST 239.45 RUVS 6.9141) (Non-Facility Price: COST: 239.45 RUVS 6.9141)
Below are examples of when Circumcision CPT code (54150-54163) will be reported:
A 4-day old baby was presented by his mother to the physician for a circumcision procedure due to cultural reasons with no risks. Physicians perform a surgical procedure with ring block. The circumcision procedure was done successfully.
A 25-year-old male presents to the office with urinary tract symptoms. The patient has severe itching in the inguinal region. The patient denies any headache, numbness, weakness, dry skin, body aches.
Physical exam revealed that the patient has a swelling, urinary bladder region. The physician ordered a urinalysis and culture that revealed a severe urinary tract infection. The physician suggested the patient a circumcision procedure to lower the chances of UTI.
A 14-year-old male had circumcision and presented for a follow-up visit post- circumcision. The physician suggested the patient the revision of the circumcision procedure. It was not done correctly and was incomplete. A repair circumcision procedure was performed and was done successfully.
A 23-day old baby was presented with his father for a strong family history of penile cancer. As a result, physicians suggest the baby’s father for a circumcision procedure. The circumcision procedure was scheduled for tomorrow after the agreement of the father. The circumcision procedure was done successfully without any complications.
Circumcision CPT Code 2019
The line 413 Balanoposthitis and disorder of penis and line 21 Vesicoureteral reflux were added to Circumcision codes (CPT 54150-54161) in 2019 for reimbursement. These diseases were non-covered before the 2019 CPT codes.
Revision Of Circumcision CPT Code
CPT codes 54162 and 54163 will be reported for revision of circumcision or complication developed in post-circumcision.
CPT Code For Circumcision For Adults
CPT code 54161 will be reported for the circumcision of adults. In addition, any individual who has circumcision and is older than 28 days (about four weeks) will be reported with this CPT code 54161.
CPT Code For Newborn Clamp Circumcision
CPT code 54150 will be reported for circumcision when performed using a clamp with ring block or regional dorsal penile, while circumcision without a clamp will be reported with CPT 54160 for 28 days (about four weeks) or less.