The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 54405. Full schedules include every locality, modifier, and age-band variant.
- Every code on all 51 published schedules
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Publishing states
26
Median % of Medicare
81.5%
Rate range
$427.30 - $17,117.58
54405 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alaska | $1,323.87 | 181.7% | -- | 2026 |
| Arkansas | $17,117.58* | 95% | -- | 2026 |
| Colorado | $824.70 | 113.2% | Required | 2026 |
| Connecticut | $499.07 | 68.5% | Required | 2026 |
| District of Columbia | $636.75 | 87.4% | Required | 2026 |
| Hawaii | $816.06 | 112% | -- | 2025 |
| Illinois | $537.49 | 73.8% | -- | 2024 |
| Kentucky | $855.35 | 117.4% | Required | 2026 |
| Massachusetts | $593.67 | 81.5% | -- | 2025 |
| Maine | $499.72 | 68.6% | -- | 2026 |
| Michigan | $464.77 | 63.8% | -- | 2026 |
| Minnesota | $532.61 | 73.1% | Required | 2026 |
| North Dakota | $778.77 | 106.9% | Not required | 2026 |
| New Hampshire | $537.55 | 73.8% | Required | 2026 |
| New Jersey | $653.25 | 89.6% | Not required | 2026 |
| Nevada | $964.77 | 132.4% | -- | 2024 |
| New York | $717.90 | 98.5% | -- | 2026 |
| Ohio | $575.88 | 79% | -- | 2024 |
| Oklahoma | $651.83 | 89.4% | -- | 2026 |
| Oregon | $578.37* | 79.4% | -- | 2026 |
| Rhode Island | $14,847.59 | -- | -- | 2026 |
| South Carolina | $537.46 | 73.7% | -- | 2024 |
| Virginia | $631.37* | 86.6% | -- | 2026 |
| Vermont | $591.81 | 81.2% | -- | 2026 |
| Washington | $427.30 | 58.6% | -- | 2026 |
| West Virginia | $525.82 | 72.1% | -- | 2026 |
Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. Rows marked * are representative published variants or methodology-derived rates. "--" in the prior-auth column means the state publishes no PA flag.
Related physician codes
- 10004 - Needle biopsy without imaging, each added lesion
- 10005 - Needle biopsy with ultrasound guidance, first lesion
- 10006 - Needle biopsy with ultrasound guidance, each added lesion
- 10007 - Needle biopsy with fluoroscopic guidance, first lesion
- 10009 - Needle biopsy with CT guidance, first lesion
- 10011 - Needle biopsy with MRI guidance, first lesion
- 10012 - Needle biopsy with MRI guidance, each added lesion
- 10021 - Fine needle aspiration biopsy, first lesion, no imaging
Frequently asked questions
How much does Medicaid pay for 54405?
26 state Medicaid programs publish a fee-for-service rate for 54405 (penile implant insertion, multi-part inflatable), ranging from $427.30 in Washington to $17,117.58 in Arkansas, with a median of 81.5% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for 54405?
Arkansas publishes the highest Medicaid rate for 54405 at $17,117.58 (95% of the national Medicare amount). Washington publishes the lowest at $427.30.
Does 54405 require prior authorization under Medicaid?
6 of the 26 publishing states flag 54405 as requiring prior authorization (always or conditionally) on their fee schedules. States without a flag publish no PA indicator for this code - that means "not published", not "no PA required".