Summary & Overview
CPT 55405: Vasovasostomy, Surgical Reversal of Vasectomy
CPT code 55405 is a critical billing code for vasovasostomy, vasovasorrhaphy, a surgical procedure aimed at reversing male sterilization by reconnecting the vas deferens. This code is widely used in urology practices and is typically performed in ambulatory surgical centers, reflecting its importance in reproductive health and male fertility restoration. Nationally, the procedure is relevant for patients seeking to reverse a prior vasectomy, and it is covered by major payers such as Blue Cross Blue Shield.
This publication provides a comprehensive overview of CPT code 55405, including payer coverage, clinical context, and related billing codes. Readers will gain insights into benchmarks for utilization, policy updates affecting reimbursement, and the clinical scenarios in which this procedure is indicated. The analysis also highlights common modifiers used in billing, associated provider taxonomies, and relevant ICD-10 diagnoses that support medical necessity. By understanding these elements, stakeholders can better navigate the complexities of medical billing and policy for vasovasostomy procedures.
Key takeaways include the role of CPT code 55405 in urology, payer coverage details, and the broader clinical and billing landscape for male sterilization reversal procedures.
CPT Code Overview
CPT code 55405 represents vasovasostomy, vasovasorrhaphy, a surgical procedure performed by urology specialists to restore fertility by reconnecting the vas deferens after a prior vasectomy. This procedure is typically conducted in an ambulatory surgical center (Place of Service 24), offering a minimally invasive setting for patients. As a key service in urology, vasovasostomy addresses the clinical need for reversal of male sterilization and is performed by physicians specializing in urology and related subspecialties.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves a male patient who previously underwent a vasectomy and now seeks to restore fertility. The patient presents to a urology clinic for evaluation and is scheduled for a vasovasostomy (55405) at an ambulatory surgical center (POS 24). The clinical workflow includes preoperative assessment, surgical reversal of the vasectomy, and postoperative follow-up to monitor for restoration of sperm flow and potential complications. The procedure is performed by a urology specialist, and may involve bilateral repair depending on the patient's anatomy and prior surgical history.
Coding Specifications
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Modifiers:
50- Bilateral Procedure: Used when the vasovasostomy is performed on both sides.51- Multiple Procedures: Used when more than one procedure is performed during the same operative session.
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
208800000X | Urology Physician |
2088P0231X | Pediatric Urology Physician |
2088S0127X | Female Pelvic Medicine and Reconstructive Surgery Physician |
These taxonomies represent providers specializing in urology, pediatric urology, and female pelvic medicine and reconstructive surgery, all of whom may be involved in performing or managing vasovasostomy procedures.
Related Diagnoses
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N47.8- Other disorders of the prepuce: Relevant if prepuce abnormalities are identified during evaluation or surgery. -
N50.89- Other specified disorders of male genital organs: Used for specific but less common male genital disorders that may be addressed during vasovasostomy. -
Z31.0- Encounter for reversal of previous sterilization: Directly applicable to patients seeking vasovasostomy to restore fertility after vasectomy. -
N50.9- Disorder of male genital organs, unspecified: Used when a general disorder of the male genital organs is present without a more specific diagnosis. -
Z98.52- Vasectomy status: Indicates the patient has a history of vasectomy, which is the primary reason for considering vasovasostomy.
Related CPT Codes
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55250- Vasectomy, unilateral or bilateral: This code represents the original sterilization procedure that is being reversed by vasovasostomy. It is clinically relevant as patients with a history of vasectomy are candidates for vasovasostomy. -
55300- Vasotomy, cannulization of vas deferens: This procedure involves accessing the vas deferens and may be performed as part of diagnostic or preparatory steps in vasovasostomy. -
55500- Excision of hydrocele; unilateral: While not directly related to vasovasostomy, this procedure may be performed concurrently if a hydrocele is present and requires surgical management during the same session. -
55600- Vasovasostomy, vasovasorrhaphy with microscope: This code is an alternative to55405when microsurgical techniques are used, often preferred for improved outcomes in vasovasostomy. It is commonly used as an alternative or in conjunction with55405depending on the surgical approach.
National Reimbursement Benchmarks
For CPT code 55405, the national mean rate for Blue Cross Blue Shield and BUCA (average commercial) is $80.02. Medicare rates are not available in the input for comparison. Both commercial payers show identical mean rates, indicating a uniform reimbursement landscape for this code.
Rate dispersion is minimal across Blue Cross Blue Shield and BUCA, with the 25th, 50th, and 75th percentiles all at $80.00. This suggests extremely tight pricing, with no variation between the lower and upper quartiles. 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.