Summary & Overview
CPT 55250: Vasectomy, Unilateral or Bilateral, with Postop Semen Exam
CPT 55250 codes for vasectomy—surgical male sterilization performed unilaterally or bilaterally—with included postoperative semen examination(s). As a common office-based urology procedure, it carries clinical and administrative importance across outpatient care, preventive services, and reproductive health programs nationally. Clarity around coding supports appropriate claims submission, coverage determinations, and patient counseling.
Key payers referenced include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. Readers will find an overview of clinical context for vasectomy services, typical sites of service, and related billing considerations. The publication outlines common modifiers and related codes for counseling and reversal procedures, summarizes relevant diagnosis links for billing, and highlights variations payers may address in policy language.
This summary equips clinicians, billing staff, and policy analysts with a concise reference to the code’s clinical scope, payer coverage landscape, and where to look for further policy details. Data not available in the input will be noted where applicable, and the report does not provide clinical recommendations but rather presents coding and administrative context for national audiences.
CPT Code Overview
CPT 55250 describes a vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s). This procedure falls under the Urology service line and is typically performed in the office (POS 11) setting. The code encompasses the surgical sterilization procedure for male patients and includes related postoperative semen analysis as part of the service.
Clinical & Coding Specifications
Clinical Context
A male patient elects for definitive contraception and presents to a urology office for a vasectomy. The encounter typically begins with pre-procedure counseling and informed consent documentation, review of prior medical history and medications, focused genitourinary physical exam, and confirmation of eligibility (e.g., no active infection, informed decision). On the day of the procedure in the office (POS 11), local anesthesia is administered and a unilateral or bilateral vasectomy is performed using the chosen technique (including non-scalpel approaches). Immediate postoperative instructions are provided, including wound care, activity restrictions, and specimen collection for postoperative semen analysis(s) to confirm azoospermia. Follow-up visits are scheduled for semen examination and wound check; documentation includes the operative note, anesthesia record (if applicable), patient instructions, and semen analysis results when performed.
Coding Specifications
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Modifiers:
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22- Unusual procedural services: used when the vasectomy requires significantly greater work than typical (for example, a non-scalpel technique or unexpected intraoperative complexity that increases time or effort). Documentation must support the increased work and the additional resources/time. -
Provider taxonomies:
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