Summary & Overview
CPT 54900: Unilateral Epididymovasostomy, Surgical Repair
CPT 54900 denotes a unilateral epididymovasostomy, a microsurgical repair connecting the epididymis to the vas deferens to address obstructive causes of male infertility. As a specialized surgical code, it is relevant to urology and surgical practices that perform fertility-restorative procedures in outpatient hospital settings. Nationally, the code is important for procedural classification, billing consistency, and aligning clinical documentation with surgical service lines.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the procedure and its clinical context, typical site-of-service expectations, common billing modifiers used with intricate surgical work, associated provider taxonomies, and typical ICD-10 indications that justify medical necessity. The publication also highlights the closely related bilateral code CPT 54901 for comparative coding reference.
This summary prepares clinical administrators, coding professionals, and policy analysts to understand coding application for epididymovasostomy, where to expect services to be performed, and which payers commonly cover or process claims for this surgical intervention. Data not available in the input is noted where applicable in detailed sections.
CPT Code Overview
CPT 54900 describes a repair procedure on the epididymis specifically an epididymovasostomy, unilateral. This is a surgical procedure that restores continuity between the epididymis and the vas deferens to address obstructive azoospermia or other causes of post-vasectomy infertility. The typical site of service is Outpatient Hospital (POS 22).
Clinical & Coding Specifications
Clinical Context
A male patient with obstructive azoospermia secondary to epididymal obstruction presents for surgical reversal via epididymovasostomy. The patient typically undergoes preoperative evaluation by a urologist, including semen analysis and scrotal ultrasound, and is scheduled to receive the unilateral microsurgical anastomosis of the vas deferens to the epididymal tubules under general or regional anesthesia in an outpatient hospital setting (POS 22). Intraoperative findings guide repair; if unilateral disease is identified, the procedure corresponds to the unilateral code 54900. Postoperative workflow includes recovery in PACU, short-term pain control, wound care instructions, and follow-up semen analyses to assess patency.
Coding Specifications
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Modifiers
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51- Multiple Procedures: Used when54900is performed in the same operative session with additional distinct surgical procedures; typically reported in conjunction with a primary procedure code according to payer rules. -
59- Distinct Procedural Service: Used when54900represents a distinct procedural service separate from other services performed on the same day, when documentation supports distinct procedural circumstances. -
Provider Taxonomies
| Taxonomy Code | Specialty |
|---|---|
208800000X | Urology Physician |
2086S0122X | Surgery Physician |
2086X0206X | Surgical Oncology Physician |
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Notes
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Apply modifiers only when documentation supports the billing rationale and payer-specific modifier policies.
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The listed taxonomies identify clinicians likely to perform or bill for
54900.
Related Diagnoses
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N47.8— Other disorders of prepuce- Relevance: Scrotal or preputial pathology may coexist in patients undergoing male genital surgery and could be documented in the preoperative assessment when present.
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N50.89— Other specified disorders of male genital organs- Relevance: Includes specified epididymal or other male genital conditions that might lead to obstructive infertility and indicate need for epididymovasostomy.
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Z31.0— Encounter for reversal of previous sterilization- Relevance: Epididymovasostomy may be performed as part of a surgical approach to restore fertility after prior sterilization procedures when epididymal obstruction is implicated.
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N50.9— Disorder of male genital organs, unspecified- Relevance: Used when a specific male genital diagnosis is not yet determined but surgical exploration and repair such as
54900are performed.
- Relevance: Used when a specific male genital diagnosis is not yet determined but surgical exploration and repair such as
Related CPT Codes
| CPT Code | Description |
|---|---|
54901 | Repair Procedures on the Epididymis; epididymovasostomy, bilateral |
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54901is the bilateral counterpart to54900and is used when microsurgical epididymovasostomy is performed on both sides during the same operative session. -
In a clinical workflow,
54901is an alternative when bilateral obstruction is identified;54900and54901are not reported together for the same surgical sites. -
Common concurrent or alternative codes beyond those provided are not included per input constraints.
National Reimbursement Benchmarks
Medicare's national mean allowed rate of $738.23 sits below the BUCA (average commercial) mean of $1,043.38, reflecting a substantial gap between government reimbursement and aggregated commercial payers. The difference highlights higher commercial mean pricing compared with Medicare for CPT 54900 at the national level.
Dispersion measured as the interquartile range (P75 minus P25) varies across payers: UnitedHealth Group shows the widest spread (P75–P25 = $852.50), followed by Cigna ($741.00) and Blue Cross Blue Shield ($514.64). Medicare is the tightest with a spread of $46.00, indicating highly consistent rates across localities. The table and chart below present the full breakdown.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.