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CPT 54900: Epididymovasostomy, Unilateral Reconstructive Procedure
CPT code 54900 represents a unilateral epididymovasostomy: a microsurgical reconnection of the epididymis to the vas deferens to correct a sperm flow obstruction. Nationally, this code captures a specialized urologic reconstructive procedure used in fertility restoration and post-vasectomy vasal repair contexts. Accurate coding affects claims adjudication, provider reimbursement, and clinical reporting for reproductive surgery services.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines payer coverage patterns and coding considerations relevant to surgical urology services and fertility-related reversals.
Readers will learn the clinical context of the procedure, expected site-of-service settings, common diagnosis pairings, and related procedure coding (including the bilateral variant). The report highlights coding boundaries for a unilateral epididymovasostomy, notes related codes for bilateral procedures, and summarizes common diagnosis links that support medical necessity. Policy updates, reimbursement benchmarks, and payer-specific coverage nuances are presented for national audiences seeking clarity on billing, claims review, and coding compliance for this specialized reproductive surgery code.
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Billing Code Overview
CPT code 54900 describes an epididymovasostomy — a surgical reconnection of the epididymis to the vas deferens to correct a blockage that prevents sperm passage. The procedure in 54900 is performed on one side (unilateral).
Service type: Surgical procedure — genitourinary reconstructive surgery
Typical site of service: Ambulatory surgical center or hospital operating room
National Reimbursement Benchmarks
Commercial averages sit well above Medicare for CPT 54900: Blue Cross Blue Shield and BUCA show particularly high mean levels versus Medicare’s mean of $738.20. BUCA’s mean of $2,159.90 is roughly three times the Medicare mean, and Blue Cross Blue Shield’s mean of $2,976.60 is four times higher, reflecting a substantial gap between commercial contract averages and the Medicare baseline.
Dispersion varies widely across payers when measured as the interquartile difference (P75 minus P25). Blue Cross Blue Shield has the widest IQR at $3,035.30 ($4,118.40 − $1,083.10), followed by BUCA at $2,090.90 ($2,961.90 − $872.10), indicating broader commercial variability. Aetna is the tightest with an IQR of $551.30 ($818.00 − $126.70), with UnitedHealth Group ($175.75? wait compute) UnitedHealth Group’s IQR is $875.00 ($1,757.50 − $860.00) and Cigna’s is $908.40 ($1,683.90 − $785.50), showing moderate dispersion among national commercial payers.