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    v1.0.30
    OpenPayerBilling CodesExcision Procedures on the Spermatic CordCPT cpt-55535-abdominal-varicocele-repair-ligation-spermatic-veins
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    CPT 55535: Ligation or Excision of Varicocele via Abdominal Incision

    Medicare pays $406 and commercial payers pay $2321 on average nationally for this procedure.

    CPT code 55535 describes open surgical ligation or excision of one or more spermatic veins to treat a varicocele via an abdominal incision; service type: open surgical varicocele repair; typical site of service: inpatient or outpatient hospital operating room or ambulatory surgery center where abdominal surgical access is performed.

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

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    National Reimbursement Benchmarks

    Medicare’s mean payment of $406 sits well below BUCA’s average commercial mean of $2,320.60, indicating a substantial gap between public and that commercial benchmark for CPT 55535. This difference highlights that commercial contracts, exemplified by BUCA, reimburse at several times the Medicare mean, while other commercial payers show a broad distribution around their means.

    Dispersion measured as the interquartile range (P75–P25) is widest for Blue Cross Blue Shield at $4,127.20 (P75 $5,144.20 minus P25 $1,017.00) and notably tightest for Aetna at $365.00 (P75 $442.00 minus P25 $68.60). UnitedHealth Group ($947.20 minus $466.40 = $480.80) and Cigna ($926.60 minus $452.10 = $474.50) show moderate dispersion, while BUCA’s IQR is $2,548.00 (P75 $3,270.40 minus P25 $722.20), reflecting substantial variability among commercial rates.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 28-year-old male presents with a 6-month history of left scrotal fullness, intermittent aching pain, and infertility workup showing decreased sperm motility. Physical exam reveals a palpable left-sided varicocele that increases with Valsalva. After failed conservative management and counseling, the urology surgeon schedules an open inguinal or retroperitoneal repair via an abdominal incision to ligate dilated spermatic veins. Preoperative evaluation includes history and physical, scrotal ultrasound to confirm venous dilation, surgical consent, and anesthesia assessment. The procedure is performed in an operating room under general or regional anesthesia. Postoperative workflow includes immediate recovery in the PACU, analgesia and wound care instructions, activity restrictions, follow-up visit for dressing removal and assessment of pain and fertility counseling, and documentation of the operative report specifying the approach, number of veins ligated, laterality, and any intraoperative findings or complications.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    55530Excision of varicocele or ligation of spermatic veins for varicocele; (separate procedure)Open scrotal/inguinal approach alternative; may be billed when the varicocele is addressed via a separate incision distinct from an abdominal approach.
    55550

    Related Modifiers

    8 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…
    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…
    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…
    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…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208800000X
    208C00000X
    208600000X
    111NI0013X
    282N00000X
    163WD1100X
    207SG0203X
    163WX0003X

    Related ICD-10-CM Codes

    25 rows

    ICD-10-CM CodeDescription
    C62.10Malignant neoplasm of unspecified descended testis
    I83.10Varicose veins of unspecified lower extremity with inflammation
    I83.90Asymptomatic varicose veins of unspecified lower extremity
    I86.1Scrotal varices
    I86.2Pelvic varices
    K83.1Obstruction of bile duct
    K83.2Perforation of bile duct
    K83.9Disease of biliary tract, unspecified
    N44.00Torsion of testis, unspecified
    N45.1Epididymitis

    Showing 1–10 of 25

    Related Payer Policy Updates

    Specialty: General Surgery1 / 3

    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-55500-SPERMATOCELE-EXCISION-SPERMATIC-CORD

    CPT 55500: Excision of Hydrocele/Spermatic Cord Lesion

    CPT-55520-SPERMATIC-CORD-EXCISION-SCROTAL-SURGERY

    CPT 55520: Spermatic Cord Resection in the Scrotum

    CPT-55530-SCROTAL-EXCISION-VARICOCELE-SPERMATIC-VEIN

    CPT 55530: Excision of Varicocele, Scrotal Approach

    CPT-55540-VARICOCELE-EXCISION-LIGATION-HERNIA-REPAIR

    CPT 55540: Varicocele Excision or Spermatic Vein Ligation with Hernia Repair

    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.
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    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.

    Laparoscopy, surgical, with ligation of spermatic veins for varicocele
    Minimally invasive alternative; used when the surgeon performs a laparoscopic ligation rather than open abdominal incision.