Summary & Overview
CPT 55405: Vasovasostomy, Surgical Reversal of Vasectomy
CPT code 55405 is a critical billing code for vasovasostomy, vasovasorrhaphy, a surgical procedure aimed at reversing male sterilization by reconnecting the vas deferens. This code is widely used in urology practices and is typically performed in ambulatory surgical centers, reflecting its importance in reproductive health and male fertility restoration. Nationally, the procedure is relevant for patients seeking to reverse a prior vasectomy, and it is covered by major payers such as Blue Cross Blue Shield.
This publication provides a comprehensive overview of CPT code 55405, including payer coverage, clinical context, and related billing codes. Readers will gain insights into benchmarks for utilization, policy updates affecting reimbursement, and the clinical scenarios in which this procedure is indicated. The analysis also highlights common modifiers used in billing, associated provider taxonomies, and relevant ICD-10 diagnoses that support medical necessity. By understanding these elements, stakeholders can better navigate the complexities of medical billing and policy for vasovasostomy procedures.
Key takeaways include the role of CPT code 55405 in urology, payer coverage details, and the broader clinical and billing landscape for male sterilization reversal procedures.
CPT Code Overview
CPT code 55405 represents vasovasostomy, vasovasorrhaphy, a surgical procedure performed by urology specialists to restore fertility by reconnecting the vas deferens after a prior vasectomy. This procedure is typically conducted in an ambulatory surgical center (Place of Service 24), offering a minimally invasive setting for patients. As a key service in urology, vasovasostomy addresses the clinical need for reversal of male sterilization and is performed by physicians specializing in urology and related subspecialties.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves a male patient who previously underwent a vasectomy and now seeks to restore fertility. The patient presents to a urology clinic for evaluation and is scheduled for a vasovasostomy (55405) at an ambulatory surgical center (POS 24). The clinical workflow includes preoperative assessment, surgical reversal of the vasectomy, and postoperative follow-up to monitor for restoration of sperm flow and potential complications. The procedure is performed by a urology specialist, and may involve bilateral repair depending on the patient's anatomy and prior surgical history.
Coding Specifications
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Modifiers:
50- Bilateral Procedure: Used when the vasovasostomy is performed on both sides.51- Multiple Procedures: Used when more than one procedure is performed during the same operative session.
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Provider Taxonomies:
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