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CPT 55250: Vasectomy with Postoperative Semen Examination
CPT code 55250 denotes a vasectomy procedure that involves cutting the vas deferens, suturing the ends, and performing a postoperative semen examination. As a common elective male sterilization procedure, it is an important code for outpatient urology and primary care surgery billing and affects national utilization and payment patterns for reproductive health services. The code is used consistently whether performed unilaterally or bilaterally.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context and coding conventions for 55250, typical sites of service, commonly associated diagnoses such as encounters for sterilization, and related procedural codes. The publication also summarizes payer coverage considerations and common billing modifiers used with outpatient surgical procedures. Content provides benchmarks and policy-relevant points to inform coding accuracy and administrative planning for providers and billing teams.
This national-level summary is intended for coding professionals, practice administrators, and clinicians involved in urology and reproductive health services seeking clear guidance on the clinical meaning and billing context of CPT code 55250.
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Billing Code Overview
CPT code 55250 describes a surgical procedure in which the vas deferens is transected and the ends are sutured, performed on the left and right sides. The procedure includes a postoperative semen examination as part of the service. Although the CPT descriptor allows for unilateral or bilateral notation, the code is reported the same way whether the procedure is performed on one side or both.
Service type: Surgical sterilization procedure (vasectomy) with postoperative semen analysis
Typical site of service: Outpatient ambulatory surgical center or physician office procedure room; may also occur in hospital outpatient departments
National Reimbursement Benchmarks
Medicare’s mean rate for CPT 55250 is $358.40, which sits below BUCA’s average commercial mean of $1,570.50. That gap of $1,212.10 highlights a substantial difference between federal reimbursement and the BUCA commercial benchmark, with commercial payers generally paying higher average rates than Medicare for this code.
Dispersion (P75 minus P25) varies notably across payers: Blue Cross Blue Shield shows the widest spread at $3,112.30 (P75 $3,662.30 minus P25 $570.00), followed by BUCA at $1,908.00 (P75 $2,344.60 minus P25 $436.30), and UnitedHealth Group at $3,589.00 (P75 $706.20 minus P25 $347.30) — UnitedHealth Group’s high spread reflects substantial variability around its mean. Aetna and Cigna present tighter ranges of $298.00 (P75 $417.50 minus P25 $119.50) and $327.50 (P75 $639.70 minus P25 $307.20), respectively, indicating more concentrated contracting outcomes.