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CPT 55535: Abdominal Varicocele Repair with Spermatic Vein Ligation
CPT code 55535 represents an open abdominal approach to ligate or excise spermatic veins for treatment of varicocele. This surgical code is used when the procedure is performed through an incision in the abdomen and can be billed for inpatient or outpatient surgical encounters. Nationally, accurate coding for varicocele repair impacts surgical quality measurement, payment integrity, and claims processing for urology and general surgery services.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. The publication outlines how payers commonly handle coverage and billing for this abdominal varicocele repair relative to related procedures, and it highlights typical sites of service and clinical context for appropriate use.
Readers will find benchmarks and coding context for CPT code 55535, comparisons to related procedures such as perineal or laparoscopic approaches, and a concise clinical description to support correct claim filing. The summary also identifies common clinical indications and where to expect the procedure to be performed, supporting revenue cycle and clinical documentation alignment across national payers.
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Billing Code Overview
CPT code 55535 describes the surgical ligation or excision of one or more spermatic veins for treatment of a varicocele via an abdominal incision. The procedure addresses dilation of the veins in the spermatic cord and may involve exploration and ligation through an abdominal approach.
Service Type: Surgical procedure — open abdominal varicocele repair
Typical Site of Service: Inpatient or outpatient operating room / ambulatory surgical center, performed by a surgeon in a procedural setting under appropriate anesthesia.
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.