When coding for surgical procedures, accuracy matters for both compliance and reimbursement. One area that often causes confusion is the CPT code for bilateral vasectomy. Since vasectomy is a permanent sterilization procedure, correct coding ensures that claims are processed without delays and follow U.S. payer guidelines.
In this guide, we’ll cover the CPT code for bilateral vasectomy, how it’s reported, billing considerations, and documentation tips.
What is a Vasectomy?
A vasectomy is a urologic procedure that blocks or cuts the vas deferens to prevent sperm from mixing with semen. It is considered a permanent method of male sterilization. A bilateral vasectomy means both sides (left and right vas deferens) are treated during the same surgical session, which is standard in the U.S.
CPT Code for Bilateral Vasectomy
The current CPT code used is:
- 55250 – Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s).
Key Points:
- The CPT code 55250 already covers both unilateral and bilateral vasectomy.
- You should not report the code twice for bilateral procedures.
- The code includes routine postoperative semen analyses, so these should not be billed separately.
Documentation Requirements
When documenting a bilateral vasectomy, providers should include:
- Indication for sterilization (e.g., patient request, informed consent).
- Technique used (ligation, cauterization, fascial interposition, clips).
- Confirmation that both sides were treated.
- Post-procedure follow-up plan, including semen analysis.
Billing and Modifier Use
Do You Need Modifier 50?
- No. Since CPT 55250 inherently includes bilateral services, appending modifier -50 is not appropriate.
- Billing twice with modifiers RT/LT is also incorrect.
Global Period
- CPT 55250 has a 90-day global period, meaning follow-up care and semen checks are bundled.
ICD-10-CM Diagnosis Codes Commonly Used
- Z30.2 – Encounter for sterilization
- Z98.52 – Vasectomy status (for history documentation)
Reimbursement Considerations
Coverage for vasectomy varies by insurance plan. While many commercial payers cover the procedure, Medicare generally does not because it is considered elective. Always check payer-specific guidelines for coverage and preauthorization requirements.
Common Coding Errors to Avoid
- Reporting CPT 55250 twice for bilateral procedures.
- Using modifier 50 unnecessarily.
- Billing separately for semen analysis post-vasectomy.
- Inadequate documentation of informed consent and both sides treated.
Final Takeaway
The correct CPT code for bilateral vasectomy is 55250. This single code covers both unilateral and bilateral procedures and includes postoperative semen analysis. Accurate coding, along with proper documentation, helps avoid denials and ensures compliance with current U.S. guidelines.