CPT code 54150 – Circumcision, fee schedule, and documentation

Key takeaways

CPT 54150 describes circumcision by clamp or device with a regional dorsal penile or ring block. Its official descriptor carries no age limit.

Age separates only CPT 54160 (neonate, 28 days of age or less) from CPT 54161 (older than 28 days). Both are surgical-excision codes, not clamp codes.

Z41.2 (Encounter for routine and ritual male circumcision) is the standard ICD-10 pairing. Medically indicated cases use a condition code such as N47.1 for phimosis.

At CY2026 RVUs and a conversion factor of $33.4009, CPT 54150 pays roughly $151.97 non-facility and $84.17 facility. The code carries a 000 global period.

Pabau, practice management software, submits and tracks 54150 claims through Claim.MD. Eligibility checks run before the visit, and denial reasons come back with the remittance.

What CPT code 54150 describes and when to use it

The American Medical Association defines CPT code 54150 as Circumcision, using clamp or other device with regional dorsal penile or ring block. The descriptor has two required elements. A clamp or equivalent device must be the technique used. A regional dorsal penile nerve block or ring block must be given at the time of the procedure.

The descriptor names no age at all. Before CPT 2007, a separate code 54152 covered the clamp technique in patients other than newborns. The AMA deleted 54152 that year and stripped the newborn wording out of 54150. Since then, a clamp circumcision is reported as 54150 for an infant, a child, or an adult.

Devices that satisfy the clamp or other device wording include the Gomco clamp, the Plastibell, and the Mogen clamp. Each crushes or ligates the prepuce instead of cutting it free by hand. Where the surgeon excises the prepuce surgically, the code moves to 54160 or 54161.

The regional block is code-defining too. A CPT parenthetical covers the case where no block is given. Report 54150 with modifier 52 for reduced services instead of reaching for a different circumcision code. Most newborn circumcisions in a hospital nursery use a local dorsal penile block, which satisfies the descriptor as written.

CPT 54150 vs 54160 vs 54161: which code applies

Technique picks the code first. A clamp or device sends the claim to 54150 at any age. Surgical excision sends it to 54160 or 54161, and only at that point does the patient’s age in days decide anything. The diagram below runs that decision from the operative note down to the code.

The 28-day threshold belongs to the 54160 and 54161 pair alone. A Gomco circumcision on a three-month-old is still 54150. Coding it 54161 would report a surgical excision that never took place, so the error misstates the technique rather than the age.

Payers can still apply their own age-based medical necessity rules to 54150. That is plan policy, and it does not change which CPT code describes the work performed. Record the device and the block in the note, so the claim matches the procedure the surgeon carried out.

ICD-10 codes that support medical necessity

Every CPT 54150 claim needs a supporting ICD-10-CM diagnosis code. Selection depends on whether the circumcision is elective or clinically indicated. Each code below has its own entry in the ICD-10-CM code reference, with the chapter and category it sits in.

Z41.2 fits most elective circumcisions. Medicare does not cover elective circumcision, so Z41.2 claims sent to Medicare are denied as not medically necessary. Where a clinical indication exists, use the condition code and record the findings in the chart. Medicaid coverage for routine circumcision varies by state, so check the state manual before billing.

CY2026 fee schedule and RVUs

Payment for CPT 54150 comes from relative value units multiplied by the Medicare conversion factor. The CMS Physician Fee Schedule lookup tool holds the authoritative rates by locality. The figures below are CY2026 national averages, before any geographic practice cost index adjustment.

Multiply total RVUs by the CY2026 conversion factor of $33.4009 to reproduce those dollar figures. Non-facility rates apply when the circumcision is performed in an office or practice setting. Facility rates apply to hospital-based circumcisions, which is the usual setting for newborns.

How Medicare and Medicaid cover circumcision

Coverage for CPT 54150 turns on medical necessity rather than on the code itself. Because 54150 is usually billed with Z41.2 for a routine or ritual circumcision, Medicare routinely denies it as a non-covered benefit. Telling the family which part of the bill their plan will not pay is far easier before the procedure than after it.

• Medicare: Does not cover elective circumcision. Where a clinical indication such as phimosis is documented, coverage may apply, subject to the Local Coverage Determination in your MAC jurisdiction.
• Medicaid: Coverage varies significantly by state. Some state programs cover routine newborn circumcision outright, while others require a documented medical indication. Check the state fee schedule and billing manual before submitting Z41.2.
• Commercial insurance: Most plans cover newborn circumcision. Some require pre-authorization, apply benefit limits, or restrict coverage past a certain age. Verify eligibility and benefits before the procedure.
• Self-pay: Where the payer excludes the procedure, the practice needs a clear self-pay fee. Many hospital-based newborn circumcisions are billed straight to the family for that reason.

What the operative note must record

Every CPT 54150 claim rests on an operative note carrying a specific set of elements. A missing element is a common trigger for record audits and post-payment recoupment. Capturing all six at the point of care is what keeps the claim clean.

• Device used: Name the specific clamp or device, such as a Gomco, a Plastibell, or a Mogen. This is the element that supports 54150 over the surgical-excision codes.
• Anesthesia type: Record that a regional dorsal penile nerve block or ring block was given, with the agent and volume. Typical practice is 0.5% to 1% lidocaine without epinephrine. Where no block was given, note that and append modifier 52.
• Indication: State whether the procedure was elective or medically indicated. This drives ICD-10 selection and the payer’s coverage determination.
• Patient age: Record the date of birth and the date of service as a matter of course. Age does not select 54150, but it does separate 54160 from 54161, and some plans set age-based coverage limits.
• Consent: Parental or guardian informed consent must be documented and retrievable from the record.
• Complications: Note any intraoperative findings or complications, or record their absence. A short line confirming the patient tolerated the procedure closes the clinical record.

Elapsed time is not among those six elements, because 54150 is billed as one unit per procedure. Time-based codes need the minutes instead, so HCPCS code G0108 is billed in 30-minute units supported by documented start and stop times. A partial increment never rounds up, and 75 minutes of training still bills as two units.

Modifiers for CPT 54150

Modifier use on CPT 54150 is limited to a few scenarios, one of which is built into the code itself.

• Modifier 52 (reduced services): Append it when the clamp circumcision is performed without the regional dorsal penile or ring block. A CPT parenthetical following the code directs this.
• Modifier 22 (increased procedural services): Use it when the work is substantially greater than usual, with documentation supporting the extra effort. Payers generally expect a cover letter.
• Modifier 59 (distinct procedural service): It may apply when 54150 is billed alongside another procedure that NCCI edits would otherwise bundle. Use it only where the services are genuinely distinct.

CPT 54150 carries a 000 global period. No post-operative days are packaged into the payment, so a related visit on a later date is billed on its own. A same-day evaluation and management service still needs modifier 25 where it was separately identifiable.

Common denial reasons and how to avoid them

CPT 54150 denials cluster around a small set of predictable errors. Most of them can be caught at the front desk or in the coding review, before the claim is ever submitted.

Billing CPT 54150 alongside CPT 99460

CPT 99460 covers initial hospital or birthing center care, per day, for the evaluation and management of a normal newborn. It is often performed on the same date as CPT 54150, which is where the bundling question starts.

Under National Correct Coding Initiative edits, 54150 and 99460 may be billed on the same date when both are performed and separately documented. The circumcision is a distinct surgical service from the newborn evaluation. The record has to show that each service was separately rendered and clinically appropriate.

• Do not bundle by reflex: The two codes cover different clinical activities. The E/M documents the newborn assessment and the surgical code documents the procedure.
• Modifier 25 on 99460: Some payers require modifier 25 on the E/M code when a procedure is billed the same day. Verify the payer’s rule before appending it.
• Same-day documentation: The operative note and the E/M note must be distinct documents, or clearly separate sections of the encounter record.
• Payer variation: Medicaid plans and commercial payers apply NCCI edits differently. Check the payer’s current edit table before billing both codes.

How Pabau supports circumcision billing accuracy

An accurate CPT 54150 claim starts in the operative note, and it stays accurate only if it reaches the payer intact. Pabau, practice management software for healthcare practices, handles that second half with claims management built in.

Claims are submitted electronically through Claim.MD, Pabau’s US clearinghouse partner, which reaches thousands of US payers. Eligibility checks run before the visit, so the front desk knows what the plan covers before a circumcision is scheduled.

Once a claim is out, electronic remittance advice comes back into the same dashboard. Denials arrive with their reason codes attached and are queued for rework, so a technique mismatch does not sit unnoticed for weeks.

Coding decisions stay with your coders. Pabau submits and tracks the claim rather than choosing the CPT code or checking the diagnosis pairing for you.

Track every circumcision claim from submission to payment

Pabau submits claims through the Claim.MD clearinghouse, checks eligibility before the visit, and returns remittance advice and denial reasons to one dashboard. Rework starts the day a denial lands, not the month after.

Book a demo

Conclusion

CPT code 54150 is chosen by technique. A clamp or device with a regional dorsal penile or ring block is 54150, whatever the patient’s age. Surgical excision is 54160 for a neonate and 54161 after 28 days. Denials on this code usually trace back to a note that never named the device or the block.

Write the operative note so the technique is unmistakable, and pair it with a diagnosis the payer accepts. Check the plan’s age policy before the visit. Pabau’s claims management software then submits, tracks, and reconciles the claim through Claim.MD. To see that workflow running on your own billing, book a demo.

Continue your research

Billing the surgical-excision technique instead of a clamp? CPT code 54161 covers circumcision by surgical excision in a patient older than 28 days, with its own RVUs and denial patterns.

Want the full CARC/RARC picture behind a denied claim? Denial codes in medical billing maps the top 20 codes payers return and how to correct each one.

Need to document why a circumcision was medically indicated? Medical necessity letter template gives the format payers expect when Z41.2 alone will not support coverage.

Frequently asked questions