Summary & Overview
CPT 55200: Vas Deferens Patency Assessment with Tubation
CPT code 55200 represents insertion of a tube into the vas deferens to assess and, if needed, relieve obstruction that may impair male fertility. This microsurgical diagnostic/operative procedure is an important part of urologic and reproductive care when evaluating obstructive azoospermia or other causes of impaired sperm transport. Nationally, it matters because it guides clinical decision-making around fertility preservation, downstream fertility interventions, and surgical management of obstructive causes.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and typical sites of service, along with the kinds of benchmarks and policy items commonly examined for this code—coverage patterns, payment considerations, and documentation elements that affect claim adjudication. The publication also outlines relevant clinical indications, expected service complexity, and where this procedure fits in care pathways for male fertility evaluation.
Data not available in the input for specific payer fee schedules, associated taxonomies, and ICD-10 diagnosis mappings. The content focuses on national-level clinical and billing context for CPT code 55200, helping payers, providers, and administrators understand what the code denotes and why it is used.
Billing Code Overview
CPT code 55200 describes a surgical procedure in which a provider inserts a tube into the vas deferens to confirm patency and identify or relieve a blockage that could impair fertility. The procedure may include making an incision in the vas deferens when necessary and can be performed on one or both sides.
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Service type: Diagnostic/operative microsurgical procedure of the male reproductive tract to assess and address vas deferens patency
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Typical site of service: Ambulatory surgical center or hospital outpatient/inpatient operating room, depending on clinical complexity and anesthesia needs
Clinical & Coding Specifications
Clinical Context
A 32-year-old male presents to a urology clinic with a 12-month history of infertility after trying to conceive with his partner. Semen analysis demonstrates low volume and poor sperm motility suspicious for distal vasal obstruction. The urologist schedules a diagnostic vasography; under local or general anesthesia in an outpatient ambulatory surgery center, the surgeon exposes the vas deferens through a small incision and inserts a fine catheter or tube into the lumen of one or both vas deferens to inject contrast and assess patency. If a focal obstruction is identified, the surgeon may make a small incision in the vas to relieve blockage or guide further surgical planning. The procedure is typically performed by a urologist with genitourinary or reproductive surgery experience. Typical workflow includes preoperative counseling, informed consent, sedation/anesthesia, sterile preparation, surgical exposure of the vas, cannulation and contrast injection, intraoperative fluoroscopic imaging as needed, wound closure, recovery, and postoperative instructions. Usual sites of service are the outpatient ambulatory surgery center or hospital operating room depending on anesthesia and comorbidities. Patient monitoring includes vital signs, assessment for bleeding or infection, and instructions regarding return to activity and follow-up for definitive corrective surgery if needed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing the physician’s professional work separately from the technical component (imaging or facility) if split billing applies. |