Billing code 55530: Varicocele repairMedicare rate & RVUs in Illinois
Reports operative ligation or excision of spermatic veins for varicocele through a nonabdominal approach, commonly for infertility or varicocele-related pain.
CMS doesn’t publish an office rate for 55530 in Illinois.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 55530 covers
A urologist exposes and ligates or removes dilated spermatic veins to treat a varicocele, often in a patient evaluated for infertility or scrotal discomfort. The operation is generally performed through an open inguinal or subinguinal exposure; the operative approach helps distinguish this code from abdominal or laparoscopic vein procedures. Documentation should identify the varicocele, the side treated, the approach, and the vein ligation or excision performed.
Select this code for the nonabdominal operation without hernia repair; an abdominal approach or a procedure combined with hernia repair has a different code. For bilateral treatment, CMS pays 150% when modifier 50 is reported. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. Assistant-at-surgery payment is barred by statutory restriction; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 55530 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | Unavailable | $360.12 |
| East St. Louis | Unavailable | $342.19 |
| Rest Of Illinois | Unavailable | $330.39 |
| Suburban Chicago | Unavailable | $349.90 |
How the 55530 rate is calculated
Each of 55530’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 55530
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 5.61Practice expense 3.44Malpractice 0.73
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 55530
55530 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 55530
Varicocele repair
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 55530
Varicocele repair
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
55530 without 50 · national facility
$326.66
Varicocele repair
55530-50 · Bilateral: 150%
$489.99
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
55530 compared with similar codes
Compare codes
55530 vs 55535 vs 55540 vs 55550: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 55535Varicocele surgery
- Choose 55530 for the nonabdominal approach; 55535 describes an abdominal approach.
- 55540Hernia and varicocele surgery
- Use 55540 when the varicocele vein procedure is combined with hernia repair; 55530 is for the varicocele procedure without that repair.
- 55550Varicocele surgery
- 55550 describes laparoscopic spermatic vein ligation. Use 55530 for the nonabdominal, nonlaparoscopic procedure.
55530 billing questions
How is this code distinguished from 55535?
This code describes the nonabdominal approach. Code 55535 is for an abdominal approach to varicocele vein ligation or excision.
Which code applies when hernia repair is also performed?
Use 55540 when varicocele vein surgery is performed with hernia repair. This code describes the varicocele procedure without that combined hernia repair.
How should bilateral treatment be reported?
Report modifier 50 for bilateral treatment. CMS pays the bilateral procedure at 150%.
Are related postoperative visits separately included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon or co-surgeon be paid?
Assistant-at-surgery payment is barred by statutory restriction. Co-surgeon payment is allowed only with supporting documentation.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
Fee sheets
Put 55530 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →