Summary & Overview
CPT 55400: Vasovasostomy, Surgical Reconnection of Vas Deferens
CPT code 55400 covers vasovasostomy, a microsurgical procedure to reconnect the vas deferens and restore male fertility following a vasectomy. This code is nationally relevant for urology practices, as it addresses the increasing demand for fertility restoration procedures. The procedure is typically performed in ambulatory surgical centers, reflecting its specialized nature and the need for advanced surgical expertise.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. Understanding coverage and reimbursement policies for these major insurers is essential for providers and stakeholders navigating the complexities of surgical billing and patient access.
Readers will gain insight into clinical indications for 55400, including common ICD-10 diagnoses such as reversal of previous sterilization and disorders of male genital organs. The publication also explores related CPT codes, typical modifiers used in billing, and the physician taxonomies associated with the procedure. Policy updates, benchmarks, and payer-specific considerations are discussed to provide a comprehensive overview of the current landscape for vasovasostomy billing and coverage. This summary serves as a resource for those seeking clarity on coding, payer requirements, and clinical context for this important urological service.
CPT Code Overview
CPT code 55400 represents vasovasostomy, vasovasorrhaphy, a surgical procedure performed to reconnect the vas deferens, typically as a means to reverse a prior vasectomy. This procedure falls under the urology service type and is commonly performed in an ambulatory surgical center (Place of Service 24). Vasovasostomy is a technically demanding operation that aims to restore fertility in men who have previously undergone sterilization. The procedure is significant in the context of reproductive health and surgical urology, offering patients an option for fertility restoration.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves a male patient who previously underwent a sterilization procedure, such as a vasectomy, and now seeks to restore fertility. The patient presents to a urology clinic for evaluation. After clinical assessment and counseling, the patient is scheduled for a vasovasostomy (CPT 55400) at an ambulatory surgical center (Place of Service 24). The procedure is performed by a urology physician, and may involve the use of modifiers if multiple procedures are performed or if the service is distinct from other procedures on the same day.
Coding Specifications
-
Modifier
51: Used when multiple procedures are performed during the same operative session. Indicates thatCPT 55400is one of several procedures. -
Modifier
59: Used to denote a distinct procedural service, such as whenCPT 55400is performed separately from other procedures that are not normally reported together.
| Modifier Code | Description |
|---|---|
51 | Multiple Procedures |
59 | Distinct Procedural Service |
Provider Taxonomies:
| Taxonomy Code | Specialty |
|---|---|
208800000X | Urology Physician |
208C00000X | Colon & Rectal Surgery Physician |
2086S0120X | Surgery Physician |
Related Diagnoses
-
N47.8- Other disorders of the prepuce- May be present as a comorbidity or incidental finding during the procedure.
-
N50.89- Other specified disorders of male genital organs- Used when the patient has a specific, documented disorder of the male genital organs relevant to the surgical intervention.
-
Z31.0- Encounter for reversal of previous sterilization- Directly relevant as the primary indication for vasovasostomy (
CPT 55400).
- Directly relevant as the primary indication for vasovasostomy (
-
N50.9- Disorder of male genital organs, unspecified- Used when the clinical documentation does not specify the exact disorder but indicates a problem with the male genital organs.
Related CPT Codes
-
55250- Vasectomy, unilateral or bilateral- Represents the original sterilization procedure that may be reversed by
CPT 55400. Not typically performed together, but relevant in patient history.
- Represents the original sterilization procedure that may be reversed by
-
55300- Vasotomy, cannulization of vas deferens- Related to surgical access of the vas deferens, which may be part of the workflow in vasovasostomy. Can be performed in conjunction with or as an alternative to
CPT 55400.
- Related to surgical access of the vas deferens, which may be part of the workflow in vasovasostomy. Can be performed in conjunction with or as an alternative to
-
55500- Excision of hydrocele; unilateral- Addresses a different male genital condition but may be performed during the same operative session if clinically indicated. Modifier
51may apply if both procedures are done.
- Addresses a different male genital condition but may be performed during the same operative session if clinically indicated. Modifier
-
55600- Vasectomy, with or without fascial interposition, unilateral or bilateral- Another form of sterilization procedure, relevant to the patient's surgical history. Not typically performed with
CPT 55400, but important for coding context.
- Another form of sterilization procedure, relevant to the patient's surgical history. Not typically performed with
National Reimbursement Benchmarks
Nationally, the mean rate for CPT code 55400 under Medicare is $465.50, while the BUCA (average commercial) mean rate is significantly higher at $662.51. Commercial payers such as UnitedHealth Group and Cigna report even higher mean rates, at $890.65 and $831.76 respectively, compared to Blue Cross Blue Shield at $618.63 and Aetna at $406.38.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies notably across payers. Medicare exhibits the tightest range ($31.00), indicating relatively consistent reimbursement rates. In contrast, UnitedHealth Group shows the widest dispersion ($529.00), followed by Cigna ($478.50), reflecting greater variability in commercial reimbursement. The table and chart below present the full breakdown of national benchmarks for each payer.
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.