$327.66–$360.52
Use 55200 for incision into the vas deferens. Use 55250 when the procedure interrupts the duct for sterilization.
On this page
CMS RVU26D · Effective 2026-10-01
55200 Vasotomy Medicare reimbursement rates in Pennsylvania
Reports a surgeon’s incision into the vas deferens, including access for vasography or another procedure requiring entry into the duct. Compare 55200 office and facility rates across CMS payment localities in Pennsylvania.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 55200 in Pennsylvania?
Pennsylvania has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$375.40–$410.77
2 of 2 localities have a supported rate.
Facility setting
$249.68–$268.21
2 of 2 localities have a supported rate.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Urology surgery
About 55200: Surgical incision of the vas deferens
Reports a surgeon’s incision into the vas deferens, including access for vasography or another procedure requiring entry into the duct.
A vasotomy is a surgical opening of the vas deferens. A urologist typically performs it in an operating room or procedure setting when access to the duct is needed, including for vasography. The code covers the incision itself; it is distinct from removing or interrupting the vas deferens for sterilization and from reconstructing a divided duct.
Report 55200 when the operative note documents the vas deferens incision and the procedure performed. The code is priced as bilateral, so modifier 50 does not increase payment. It has a 90-day global period, which includes the day-before preoperative visit and related postoperative care during that period. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 55200
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- The code is already priced as bilateral; modifier 50 does not increase payment.
- Assistant at surgery
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU4.44 · 38%
- Practice expense (office) RVU6.83 · 58%
- Malpractice RVU0.56 · 5%
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.
55200 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
No office rate
This code reports vas deferens reconstruction to restore continuity; 55200 reports an incision, not reconnection.
$93.63–$104.82
74440 reports the radiological supervision and interpretation for vasography, not the surgical incision into the vas deferens.
Compare 55200 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
2 of 2 payment localities
Metropolitan Philadelphia →
Office / nonfacility
$410.77
Facility
$268.21
Rest Of Pennsylvania →
Office / nonfacility
$375.40
Facility
$249.68
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55200 billing questions
How is 55200 different from vasectomy code 55250?
55200 reports an incision into the vas deferens, such as for duct access. 55250 reports a vasectomy performed to interrupt the duct for sterilization.
Can modifier 50 be used when both sides are treated?
The code is already priced as bilateral. Modifier 50 does not increase payment.
Can vasography imaging be reported with 55200?
When vasography is performed, the radiological supervision and interpretation service may be reported separately with 74440. The operative note should support the vasotomy and the imaging service.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
When can an assistant-at-surgery be paid?
Assistant-at-surgery payment requires documentation that the assistant was medically necessary. Co-surgeons and team surgery are not permitted for this code.
How are other same-session procedures paid?
The highest-valued procedure is paid in full; other procedures in the same session are subject to the standard multiple procedure reduction and are paid at 50%.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
6,34355150,,Removal of scrotum,A,,7.94,4.62,NA,4.62,,1.08,13.64,13.64,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,34455175,,Revision of scrotum,A,,5.72,3.70,NA,3.70,,0.75,10.17,10.17,0,090,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,34555180,,Revision of scrotum,A,,11.49,5.69,NA,5.69,,1.50,18.68,18.68,0,090,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,34655200,,Incision of sperm duct,A,,4.44,6.83,,2.73,,0.56,11.83,7.73,0,090,0.10,0.80,0.10,2,2,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,34755250,,Removal of sperm duct(s),A,,3.29,6.67,,2.82,,0.42,10.38,6.53,0,090,0.10,0.80,0.10,2,2,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,34855300,,Prepare sperm duct x-ray,A,,3.41,1.10,NA,1.10,,0.43,4.94,4.94,0,000,0.00,0.00,0.00,2,2,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,34955400,,Repair of sperm duct,A,,8.39,4.20,NA,4.20,,1.08,13.67,13.67,0,090,0.10,0.80,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00