Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.30
    OpenPayerBilling CodesRepair Procedures on the EpididymisCPT cpt-54900-epididymovasostomy-unilateral-reconstructive-surgery
    Ask Trek AI about this page

    CPT 54900: Epididymovasostomy, Unilateral

    Medicare pays $738 and commercial payers pay $2160 on average nationally for this procedure.

    CPT code 54900 describes a surgical procedure, an epididymovasostomy (unilateral), in which the surgeon connects the epididymis to the vas deferens to correct a sperm blockage; service type: surgical reproductive/genitourinary procedure; typical site of service: hospital operating room or ambulatory surgery center where microsurgical repair is performed under operative conditions.

    For related coverage guidance, see recent payer policy updates: Removal of Implantable, Outpatient Surgical Procedures - Site of Service, Surgical Procedures.

    Customize your policy alerts

    Sign up for cpt 54900 policy alerts

    Get alerted when payer policies referencing 54900 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    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.

    Table of contents

    Progress1 / 9

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • Facility ComparisonBeds, revenue & payer mix
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools
    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Clinical & Coding Specifications

    Clinical Context

    A 36-year-old male presents with infertility after a prior vasectomy. He reports normal erectile function and no partner pregnancy following attempts at conception for 18 months. Semen analysis demonstrates azoospermia with palpable vas deferens and suspected epididymal obstruction. Evaluation includes history, physical exam, scrotal ultrasound, and preoperative counseling. The urologist schedules a unilateral epididymovasostomy (54900) under general anesthesia in an outpatient surgery center. Intraoperative steps include exploration of the scrotum, identification of the vas deferens and epididymal tubules, microsurgical repair with high-magnification anastomosis of the epididymal tubule to the vas deferens on the affected side, hemostasis, and layered wound closure. Postoperative care includes short PACU recovery, scrotal support, analgesia, activity restrictions, and follow-up semen analyses at intervals to document return of sperm to the ejaculate.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    54901Repair Procedures on the Epididymis; epididymovasostomy, bilateralBilateral counterpart to 54900; used when epididymovasostomy is performed on both sides in the same operative session.

    Related Modifiers

    9 rows

    ModifierDescriptionWhen to Use
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    63Modifier‑63 is appended to surgical CPT codes (20000–69990) when a procedure is performed on a neonate or infant weighing ≤ 4 kg (about 8.8 lbs). The AMA/AAPC definition specifies this use and notes…- Use modifier -63 only for surgical procedures in the CPT 20000–69990 series performed on a neonate or infant who weighs ≤ 4 kg at the time of the procedure; it indicates increased complexity due to…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208800000X
    2086S0122X
    2086X0206X
    261QP1100X
    376J00000X
    3747P1801X
    372500000X
    363LC1500X

    Related ICD-10-CM Codes

    25 rows

    ICD-10-CM CodeDescription
    N45.1Epididymitis
    N45.2Orchitis
    N45.3Epididymo-orchitis
    N46.9Male infertility, unspecified
    N47.0Adherent prepuce, newborn
    N47.1Phimosis
    N47.8Other disorders of prepuce
    N48.5Ulcer of penis
    N48.6Induration penis plastica
    N48.89Other specified disorders of penis

    Showing 1–10 of 25

    Related Payer Policy Updates

    Specialty: General Surgery1 / 2

    10 rows

    PolicyPayerEffective Date
    Removal of ImplantableBlue Cross Blue Shield - Rhode Island2026-10-01
    Outpatient Surgical Procedures - Site of ServiceUnitedHealthcare2026-09-01
    Surgical ProceduresUnitedHealthcare2026-09-01
    Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsPremera Bluecross2026-09-01
    Site of Service Ambulatory Surgical Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsPremera Bluecross2026-09-01
    Site of Service Ambulatory Service Center (ASC) SelectPremera Bluecross2026-09-01
    Site of Service Ambulatory Surgical Center (ASC) Select — Site of Service for Ambulatory Surgical Procedures (ASC Select)Premera Bluecross2026-09-01
    Site of Service Ambulatory Service Center (ASC) SelectPremera Bluecross2026-09-01
    Medical Necessity Guidelines Inpatient Surgical CareMass General Brigham Health Plan2026-08-01
    Outpatient Surgical Procedures - Site of Servicesierra health and life2026-08-01

    Related Codes

    CPT-54901-EPIDIDYMOVASOSTOMY-BILATERAL-EPIDIDYMIS-TO-VAS

    CPT 54901: Bilateral Epididymovasostomy (Epididymis to Vas Anastomosis)

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    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.

    Rate by payer