CPT 55400 · Vasovasostomy
55400 is the vasovasostomy — reconnecting the two cut ends of the vas. If the surgeon finds a blockage closer to the testicle, the operation becomes a vasoepididymostomy, 54900 or 54901, and the bill changes with it. Here's what each covers, what success looks like, and the semen analyses that follow.
Hera doesn't perform reversals. Our part starts about six weeks after surgery: the complete semen analysis (CPT 89320) that shows whether sperm are back, repeated every three months until they are. Order through Hera and we match you to a lab near you with the physician order included, or bring the order your surgeon wrote. Upload each report and Hera's AI tracks count and motility from one test to the next.
Reversal roughly $5,000–$15,000, almost always cash-pay · follow-up semen analysis from $60 + lab price on Hera
CPT 55400 is a vasovasostomy: reopening the vas deferens on each side of the old vasectomy site and sewing the two ends back together, almost always under an operating microscope (add-on 69990). One code covers the operation whether it's done on one side or both. It's the procedure most people mean by 'vasectomy reversal', and it's the one performed when the fluid from the testicular end of the vas contains sperm or looks clear and watery.
If that fluid is thick, pasty or free of sperm, back-pressure has usually caused a second blockage in the epididymis, and reconnecting the vas alone won't work. The surgeon then joins the vas directly to the epididymis instead — a vasoepididymostomy, CPT 54900 for one side or 54901 for both. That decision is made during the operation, so a case scheduled as 55400 can legitimately be billed as 54901. Ask the surgeon beforehand whether the quote covers both possibilities.
1. Place your order with Hera about six weeks after surgery — no lab to choose. Tell us where you are and our team matches you to a nearby lab and sends the location, cash price and collection instructions by text or email within one business day. If your surgeon already wrote the order, you can bring your own.
2. Hera's physician signs the order for the complete semen analysis (CPT 89320) — count, motility, morphology and volume, not the post-vasectomy presence check. Repeat every 3 months until sperm return and hold steady; after a vasoepididymostomy that can take up to 12 months.
3. Upload each report and Hera's AI reads it against WHO 2021 limits and charts the change from the last one, so you and your surgeon can see whether the count is climbing, plateauing, or falling off — the sign of late scarring that can close the repair.
Submit your order and we match you to a lab that runs the complete analysis. Had sperm frozen during the reversal? Read what those codes mean and what storage costs.
Order the follow-up semen analysis About freezing sperm retrieved at surgeryA reversal generates a surgeon's claim, a facility claim, and then months of lab claims for the semen analyses. If you're reading a cash quote, checking whether an employer plan covers reconstruction, or making sure the follow-up test was ordered correctly, these are the codes.
| Code | What it covers |
|---|---|
| 55400 (Most common procedure) | Vasovasostomy — reconnecting the two cut ends of the vas deferens. One code covers one or both sides. |
| 54900 | Vasoepididymostomy, one side — joining the vas to the epididymis when the blockage is closer to the testicle. |
| 54901 | Vasoepididymostomy, both sides. |
| 69990 | Operating microscope — an add-on line billed with the microsurgical repair. |
| 89320 | Complete semen analysis — at 6 to 8 weeks, then every 3 months until sperm return. |
| 89264 | Identifying sperm in tissue or fluid taken during the operation. |
| 89259 | Freezing sperm retrieved at the time of reversal — a backup for IVF if the repair does not open. |
| Code | What it covers |
|---|---|
| Z31.0 (Most common procedure) | Encounter for reversal of previous sterilization — the reason for the operation. |
| Z98.52 | Vasectomy status. |
| N46.023 | Azoospermia due to obstruction of the efferent ducts — the post-vasectomy diagnosis. |
| Z31.41 | Encounter for fertility testing — the follow-up semen analyses. |
Reversal is almost always cash-pay: the diagnosis Z31.0 (encounter for reversal of previous sterilization) tells the insurer the procedure is elective, and most plans exclude it, though a growing number of employer fertility benefits cover reconstruction. The follow-up semen analysis is a separate lab claim, usually billed with Z31.41 or N46.023; Hera confirms the lab's cash price before your visit.
CPT 55400 — vasovasostomy, reconnecting the two cut ends of the vas deferens; one code covers one or both sides. If the surgeon has to bypass a blockage in the epididymis, the procedure is billed as a vasoepididymostomy instead: 54900 for one side, 54901 for both. Add-on 69990 covers the operating microscope in either case.
Because the surgeon can only choose between the two once the vas is open. Fluid from the testicular end that contains sperm or is clear means a simple reconnection (55400) will work. Thick fluid with no sperm means a second blockage in the epididymis, and the vas has to be joined to the epididymis above it (54900 for one side, 54901 for both). The second operation is longer and more technically demanding, which is why it costs more and why some surgeons quote one price that covers either outcome.
It depends mostly on how long ago the vasectomy was. When it's under about 10 years, sperm return to the ejaculate (patency) in roughly 90% of vasovasostomies; the rate falls with time and is noticeably lower past 15 years, partly because older obstructions more often need a vasoepididymostomy, which has lower patency. Pregnancy rates are lower than patency rates and depend on your partner's age and fertility too. The AUA/ASRM guideline (2020, amended 2024) says couples who want a child after vasectomy should be counseled that surgical reconstruction, surgical sperm retrieval with IVF, or both are viable options, and that microsurgical reconstruction may succeed when the obstruction is in the vas or epididymis.
First at about 6 to 8 weeks, then every 3 months until sperm counts return and hold steady — up to 12 months after a vasoepididymostomy, which reopens more slowly. Ask for the complete semen analysis, CPT 89320, not 89321. The post-vasectomy check (89321) only says whether any sperm are present and moving; after a reversal you need the count, motility and morphology to know whether the repair is working and to catch a falling count, which can mean the connection is scarring closed.
Z31.0, encounter for reversal of previous sterilization, is the primary code, with Z98.52 (vasectomy status) recording the earlier procedure. The underlying condition is N46.023, azoospermia due to obstruction of the efferent ducts — the post-vasectomy diagnosis. The follow-up semen analyses are usually ordered with Z31.41, encounter for fertility testing, or N46.023 until sperm return.
Rarely. Z31.0 marks it as elective reversal of a voluntary sterilization, which most plans exclude, so surgeons quote a cash package of roughly $5,000 to $15,000 that may or may not include the facility, anesthesia and the switch to vasoepididymostomy. Some employer fertility benefits do cover reconstruction, so it's worth a call to your plan. The follow-up semen analysis is a separate lab charge, from $60 plus the lab's price on Hera.
Many surgeons offer to retrieve and freeze sperm from the vas or epididymis at the time of surgery (CPT 89264 to identify sperm in the fluid, 89259 to freeze it, then yearly storage under 89343). It's a backup for IVF with ICSI if the reversal fails or scars closed later, and the guideline notes that in obstructive azoospermia sperm for IVF can be taken from either the testis or the epididymis. It adds cost and yearly storage fees, so weigh it against how long ago the vasectomy was and whether IVF is realistically on the table for you.