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CPT 54901: Bilateral Epididymovasostomy (Epididymis to Vas Deferens)
CPT code 54901 represents a bilateral epididymovasostomy, the microsurgical anastomosis connecting the epididymis to the vas deferens to correct obstructive azoospermia. Nationally, this code captures a specialized urologic reproductive surgery with implications for fertility restoration and procedural coverage decisions. Use of the code is concentrated among surgical and urology practices providing microsurgical infertility services.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the procedure, payer coverage considerations, typical sites of service, and how 54901 relates to the unilateral code 54900.
The publication presents benchmarks and coding relationships relevant to billing and claims processing for bilateral epididymovasostomy, highlights clinical indications that commonly justify the service, and notes administrative considerations for facility versus physician claims. It is intended for coding professionals, practice managers, and clinicians involved in reproductive urology and surgical billing who require a clear, national-level summary of CPT code 54901.
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Billing Code Overview
CPT code 54901 describes an epididymovasostomy, a bilateral surgical reconnection of the epididymis to the vas deferens. The procedure is performed to correct an obstruction that prevents sperm from passing from the epididymis into the vas deferens.
Service type: Surgical reproductive/urologic repair
Typical site of service: Hospital operating room or ambulatory surgical center, performed by a urology or surgery specialist under operative conditions.
National Reimbursement Benchmarks
Medicare’s mean rate of $968.10 sits well below BUCA’s average commercial mean of $2,406.00, highlighting a substantial gap between federal reimbursement and this commercial benchmark. This gap of $1,437.90 underscores that commercial averages can be roughly 2.5x Medicare for CPT 54901, with individual commercial payers varying widely above and below BUCA’s mean.
Dispersion measured by the interquartile range (P75 minus P25) is widest for Blue Cross Blue Shield at $3,267.10 and narrowest for Aetna at $918.00; UnitedHealth Group and Cigna show intermediate dispersion at $1,165.00 and $1,195.30 respectively, while BUCA’s IQR is $2,335.60 and Medicare’s is $57.00. These differences indicate that Blue Cross Blue Shield and BUCA exhibit the largest middle-50% spread, whereas Aetna and Medicare are comparatively tight.