How To Use CPT Code 55980

CPT 55980 describes a series of staged procedures performed by a healthcare provider to convert female anatomy to male anatomy. These procedures may involve the removal of the uterus and ovaries, reshaping of genital tissue to appear more male, and the construction of a penis. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 55980?

CPT 55980 is a code used to describe a series of staged procedures performed by a healthcare provider to convert female anatomy to male anatomy. These procedures may include the removal of the uterus and ovaries, reshaping of genital tissue to appear more male, and the construction of a penis using various techniques such as using the clitoris or free tissue grafts from other parts of the body. The provider may also insert prosthetic testicles and close or remove the vagina to complete the transformation.

2. Official Description

The official description of CPT code 55980 is: ‘Intersex surgery; female to male.’

3. Procedure

1. The patient is appropriately prepped and anesthetized for the procedure.
2. The healthcare provider begins by removing the uterus and ovaries.
3. For the construction of a penis, the provider may use the clitoris that has been enlarged by hormones or free tissue grafts from the arm, thigh, or belly.
4. If a penis is constructed, the provider reroutes the urethra through the fabricated penis to allow for urination.
5. The adjacent skin is used to form the scrotum, and prosthetic testicles are inserted into the constructed pouch.
6. The provider then closes or removes the vagina to complete the transformation.

4. Qualifying circumstances

CPT 55980 is performed on individuals who are seeking to transition from female to male. The procedures are typically performed by a healthcare provider who specializes in gender reassignment surgery. The patient must meet certain criteria and undergo a thorough evaluation before being deemed eligible for the procedure. Coverage for gender reassignment surgery and the staged procedures involved may vary by payer, so it is important to check individual payer’s guidelines.

5. When to use CPT code 55980

CPT code 55980 should be used when a healthcare provider performs a series of staged procedures to convert female anatomy to male anatomy. It is important to note that coverage for these procedures may vary by payer, so it is essential to review individual payer’s guidelines to determine when to use this code.

6. Documentation requirements

To support a claim for CPT 55980, the healthcare provider must document the following information:

• Preoperative evaluation and assessment of the patient
• Details of the specific procedures performed, including the removal of the uterus and ovaries, construction of the penis, and any other relevant procedures
• Documentation of any complications or unexpected findings during the procedure
• Postoperative care and follow-up plans
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 55980, it is important to ensure that the procedures performed meet the criteria outlined in the official description. It is also crucial to review individual payer’s guidelines for coverage and reimbursement policies. Additionally, consider reporting any additional services or procedures performed in conjunction with CPT 55980, as appropriate, using the appropriate modifiers and codes.

8. Historical information

CPT 55980 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A healthcare provider performs a series of staged procedures to convert female anatomy to male anatomy for a patient seeking gender reassignment.
2. Using the clitoris that has been enlarged by hormones, a healthcare provider constructs a penis for a patient undergoing female to male transition.
3. A healthcare provider removes the uterus and ovaries and reshapes genital tissue to appear more male for a patient seeking gender reassignment.
4. Using free tissue grafts from the arm, thigh, or belly, a healthcare provider constructs a penis for a patient undergoing female to male transition.
5. A healthcare provider reroutes the urethra through a fabricated penis and inserts prosthetic testicles into the scrotum for a patient seeking gender reassignment.
6. A healthcare provider closes or removes the vagina to complete the transformation from female to male for a patient undergoing gender reassignment.
7. Using a combination of techniques, including the removal of the uterus and ovaries, construction of a penis, and closure of the vagina, a healthcare provider performs a series of procedures to convert female anatomy to male anatomy for a patient seeking gender reassignment.
8. A healthcare provider uses free tissue grafts from the arm, thigh, or belly to construct a penis and inserts prosthetic testicles into the scrotum for a patient undergoing female to male transition.
9. For a patient seeking gender reassignment, a healthcare provider removes the uterus and ovaries and reshapes genital tissue to appear more male, creating a more masculine appearance.
10. A healthcare provider performs a series of staged procedures, including the removal of the uterus and ovaries, construction of a penis, and closure of the vagina, to convert female anatomy to male anatomy for a patient seeking gender reassignment.