$403.46
55200 represents an incision of the vas deferens. Use 55250 when the purpose is permanent contraception through interruption of both ducts.
On this page
CMS RVU26D · Effective 2026-10-01
55250 Vasectomy Medicare reimbursement rates in Rhode Island
A vasectomy interrupts both vas deferens for permanent male contraception, with postoperative semen examinations included in the service. Compare 55250 office and facility rates across CMS payment localities in Rhode Island.
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 55250 in Rhode Island?
Rhode Island has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$354.63
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
Facility setting
$221.79
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
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 procedure
About 55250: Bilateral vasectomy for permanent contraception
A vasectomy interrupts both vas deferens for permanent male contraception, with postoperative semen examinations included in the service.
55250 represents surgical interruption of both vas deferens to provide permanent contraception. A urologist typically performs the procedure in an office or ambulatory surgery setting, commonly with local anesthesia. The service includes postoperative semen examinations used to assess for sperm after the procedure. It is selected for vas deferens interruption, rather than an incision performed for another purpose or surgery to restore duct continuity.
Report the operation once; CMS pricing already accounts for bilateral treatment, so modifier 50 does not increase payment. Documentation should support the contraception indication and record the operative treatment of both ducts. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When another procedure is performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Assistant-at-surgery services are not paid; co-surgeons and team surgery are not permitted.
CMS billing rules for 55250
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU3.29 · 32%
- Practice expense (office) RVU6.67 · 64%
- Malpractice RVU0.42 · 4%
81
Medicare services in 2024 · #5043 by national volume
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.
55250 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
No office rate
55400 is used for vas deferens reconstruction to restore continuity, such as after a prior vasectomy; 55250 is the interruption procedure.
89310
No office rateSemen analysis w/count
89310 is a semen analysis service. Postoperative semen examinations associated with 55250 are included in the vasectomy service.
Compare 55250 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.
1 of 1 payment localities
Rhode Island →
Office / nonfacility
$354.63
Facility
$221.79
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 55250 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
6,347
- Code
- 55250
- Physician work
- 3.29
- Practice expense
- 6.67
- Malpractice
- 0.42
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.29 | × 1.019 | 3.3525 |
| Practice expense | 6.67 | × 1.033 | 6.8901 |
| Malpractice | 0.42 | × 0.892 | 0.3746 |
| Total RVUs | 10.6173 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Rhode Island$354.63
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.29 | 1.019 |
| Practice expense | 6.67 | 1.033 |
| Malpractice | 0.42 | 0.892 |
(3.29 × 1.019 + 6.67 × 1.033 + 0.42 × 0.892) × $33.4009 = $354.63
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.29 | 1.019 |
| Practice expense | 2.82 | 1.033 |
| Malpractice | 0.42 | 0.892 |
(3.29 × 1.019 + 2.82 × 1.033 + 0.42 × 0.892) × $33.4009 = $221.79
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
55250 billing questions
Should modifier 50 be appended?
No. CMS prices 55250 as bilateral, and modifier 50 does not increase payment.
Are postoperative semen examinations included?
Yes. The service includes postoperative semen examinations related to assessing the vasectomy result.
What does the 90-day global period include?
It includes the day-before preoperative visit and 90 days of related postoperative care.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures are subject to the standard multiple-procedure reduction.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery services are not paid for this code. CMS also does not permit co-surgeons or team surgery.
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.
6,34455175,,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
6,35055500,,Removal of hydrocele,A,,6.06,4.02,NA,4.02,,0.93,11.01,11.01,0,090,0.10,0.80,0.10,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537