CPT code 56441: Labial adhesion lysis, labial adhesions2026 Medicare rate & RVUs in Ohio
Reports procedural separation of fused labial tissue, commonly for symptomatic labial adhesions when a clinician performs lysis in an office or procedure setting.
In Ohio, Medicare pays $173.31 for 56441 in the office and $135.19 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 56441 nationwide
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 11 sections
What 56441 covers
This service involves separating adhesions that join the labia, typically the labia minora. It is often performed for a child with symptomatic fusion, such as urine trapping, spraying, or local discomfort. A pediatric or general gynecologist, or another qualified clinician, may perform the procedure in an office or procedure setting; the technique and need for anesthesia depend on the patient and extent of the adhesion.
Report 56441 when the clinician actually performs lysis, not merely evaluates the adhesions or recommends conservative treatment. The note should identify the adhesion, clinical indication, and procedure performed. CMS assigns a 10-day global period, so related postoperative visits during that period are included. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are 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.
How Ohio compares for 56441
Across 109 of 109 payment localities, the office rate for 56441 runs from $162.03 in Arkansas to $230.84 in San Benito County, CA. Ohio pays $173.31. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Ohio · this page$173.31
- Los Angeles, CA · California$200.50+$27.19
- Washington, DC area · District of Columbia$205.93+$32.62
- Miami, FL · Florida$204.05+$30.74
- Chicago, IL · Illinois$198.06+$24.75
- Manhattan, NY · New York$210.28+$36.97
- Alaska · Alaska$217.01+$43.70
Other areas in Ohio first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $164.29 | $127.76 |
| ArkansasArkansas | $162.03 | $126.16 |
| ArizonaArizona | $177.47 | $137.02 |
| Bakersfield, CACalifornia | $189.28 | $143.52 |
| Chico, CACalifornia | $188.32 | $142.56 |
| El Centro, CACalifornia | $188.38 | $142.62 |
| Fresno, CACalifornia | $188.32 | $142.56 |
| Hanford, CACalifornia | $188.32 | $142.56 |
| Madera, CACalifornia | $188.32 | $142.56 |
| Merced, CACalifornia | $188.32 | $142.56 |
| Modesto, CACalifornia | $188.32 | $142.56 |
| Napa, CACalifornia | $214.38 | $159.36 |
| Oxnard, CACalifornia | $199.08 | $149.73 |
| Redding, CACalifornia | $188.32 | $142.56 |
| Rest of CaliforniaCalifornia | $188.32 | $142.56 |
| Riverside, CACalifornia | $191.98 | $146.23 |
| Sacramento, CACalifornia | $196.62 | $148.06 |
| Salinas, CACalifornia | $195.87 | $147.48 |
| San Diego, CACalifornia | $199.76 | $149.83 |
| Marin County, CACalifornia | $225.61 | $166.74 |
| San Francisco, CACalifornia | $225.23 | $166.36 |
| San Benito County, CACalifornia | $230.84 | $170.64 |
| Santa Clara County, CACalifornia | $229.26 | $169.06 |
| San Luis Obispo, CACalifornia | $192.84 | $145.29 |
| Santa Cruz, CACalifornia | $201.10 | $150.37 |
| Santa Maria, CACalifornia | $196.41 | $147.73 |
| Santa Rosa, CACalifornia | $203.06 | $151.79 |
| Stockton, CACalifornia | $188.32 | $142.56 |
| Vallejo, CACalifornia | $213.83 | $158.80 |
| Visalia, CACalifornia | $188.32 | $142.56 |
| Yuba City, CACalifornia | $188.32 | $142.56 |
| ColoradoColorado | $187.41 | $142.98 |
| ConnecticutConnecticut | $194.17 | $149.21 |
| DelawareDelaware | $180.29 | $139.04 |
| Fort Lauderdale, FLFlorida | $192.91 | $150.62 |
| Rest of FloridaFlorida | $183.45 | $143.54 |
| Atlanta, GAGeorgia | $186.53 | $144.11 |
| Rest of GeorgiaGeorgia | $173.19 | $135.94 |
| Hawaii, Guam, HIHawaii | $192.00 | $144.53 |
| IowaIowa | $166.58 | $128.38 |
| IdahoIdaho | $167.97 | $129.56 |
| East St. Louis, ILIllinois | $185.47 | $147.06 |
| Rest of IllinoisIllinois | $179.61 | $141.49 |
| Suburban Chicago, ILIllinois | $194.44 | $151.56 |
| IndianaIndiana | $168.85 | $130.15 |
| KansasKansas | $166.64 | $128.89 |
| KentuckyKentucky | $169.73 | $132.61 |
| New Orleans, LALouisiana | $177.71 | $138.42 |
| Rest of LouisianaLouisiana | $169.79 | $132.84 |
| Metropolitan Boston, MAMassachusetts | $204.23 | $154.38 |
| Rest of MassachusettsMassachusetts | $186.69 | $142.73 |
| Baltimore area, MDMaryland | $193.79 | $148.99 |
| Rest of MarylandMaryland | $183.36 | $141.11 |
| Rest of MaineMaine | $169.66 | $131.25 |
| Southern Maine, MEMaine | $177.23 | $135.86 |
| Detroit, MIMichigan | $186.48 | $146.19 |
| Rest of MichiganMichigan | $174.68 | $136.56 |
| MinnesotaMinnesota | $177.43 | $134.46 |
| Metropolitan Kansas City, MOMissouri | $175.69 | $136.49 |
| Metropolitan St. Louis, MOMissouri | $177.34 | $137.59 |
| Rest of MissouriMissouri | $167.55 | $131.56 |
| MississippiMississippi | $164.78 | $128.83 |
| MontanaMontana | $182.35 | $140.60 |
| North CarolinaNorth Carolina | $171.22 | $132.27 |
| North DakotaNorth Dakota | $175.62 | $133.87 |
| NebraskaNebraska | $167.20 | $128.67 |
| New HampshireNew Hampshire | $185.26 | $141.80 |
| Northern New JerseyNew Jersey | $204.12 | $155.69 |
| Rest of New JerseyNew Jersey | $195.78 | $150.19 |
| New MexicoNew Mexico | $175.92 | $137.63 |
| NevadaNevada | $180.58 | $138.78 |
| NYC suburbs and Long Island, NYNew York | $216.20 | $166.56 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $197.71 | $151.99 |
| Queens, NYNew York | $210.75 | $161.40 |
| Rest of New YorkNew York | $173.74 | $134.07 |
| OklahomaOklahoma | $168.58 | $131.29 |
| Portland, OROregon | $192.19 | $145.81 |
| Rest of OregonOregon | $178.58 | $136.99 |
| Metropolitan Philadelphia, PAPennsylvania | $190.06 | $146.60 |
| Rest of PennsylvaniaPennsylvania | $173.12 | $134.79 |
| Puerto RicoPuerto Rico | $183.36 | $141.15 |
| Rhode IslandRhode Island | $185.86 | $142.74 |
| South CarolinaSouth Carolina | $172.67 | $134.09 |
| South DakotaSouth Dakota | $174.83 | $133.08 |
| TennesseeTennessee | $167.54 | $129.58 |
| Austin, TXTexas | $187.31 | $143.14 |
| Beaumont, TXTexas | $172.09 | $134.10 |
| Brazoria, TXTexas | $179.45 | $138.07 |
| Dallas, TXTexas | $180.93 | $139.34 |
| Fort Worth, TXTexas | $180.02 | $138.86 |
| Galveston, TXTexas | $180.21 | $138.75 |
| Houston, TXTexas | $186.43 | $144.97 |
| Rest of TexasTexas | $175.90 | $136.28 |
| UtahUtah | $174.90 | $135.65 |
| VirginiaVirginia | $177.24 | $136.20 |
| Virgin Islands, VIUnited States Virgin Islands | $183.36 | $141.15 |
| VermontVermont | $175.71 | $134.37 |
| Rest of WashingtonWashington | $186.09 | $142.12 |
| King County, WAWashington | $207.46 | $156.24 |
| WisconsinWisconsin | $170.09 | $130.09 |
| West VirginiaWest Virginia | $173.48 | $137.20 |
| WyomingWyoming | $179.42 | $137.67 |
56441 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$162.03
$217.01
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $217.01 | 1 |
| AL | $164.29 | 1 |
| AR | $162.03 | 1 |
| AZ | $177.47 | 1 |
| CA | $188.32–$230.84 | 29 |
| CO | $187.41 | 1 |
| CT | $194.17 | 1 |
| DC | $205.93 | 1 |
| DE | $180.29 | 1 |
| FL | $183.45–$204.05 | 3 |
| GA | $173.19–$186.53 | 2 |
| GU | $192.00 | 1 |
| HI | $192.00 | 1 |
| IA | $166.58 | 1 |
| ID | $167.97 | 1 |
| IL | $179.61–$198.06 | 4 |
| IN | $168.85 | 1 |
| KS | $166.64 | 1 |
| KY | $169.73 | 1 |
| LA | $169.79–$177.71 | 2 |
| MA | $186.69–$204.23 | 2 |
| MD | $183.36–$205.93 | 3 |
| ME | $169.66–$177.23 | 2 |
| MI | $174.68–$186.48 | 2 |
| MN | $177.43 | 1 |
| MO | $167.55–$177.34 | 3 |
| MS | $164.78 | 1 |
| MT | $182.35 | 1 |
| NC | $171.22 | 1 |
| ND | $175.62 | 1 |
| NE | $167.20 | 1 |
| NH | $185.26 | 1 |
| NJ | $195.78–$204.12 | 2 |
| NM | $175.92 | 1 |
| NV | $180.58 | 1 |
| NY | $173.74–$216.20 | 5 |
| OH | $173.31 | 1 |
| OK | $168.58 | 1 |
| OR | $178.58–$192.19 | 2 |
| PA | $173.12–$190.06 | 2 |
| PR | $183.36 | 1 |
| RI | $185.86 | 1 |
| SC | $172.67 | 1 |
| SD | $174.83 | 1 |
| TN | $167.54 | 1 |
| TX | $172.09–$187.31 | 8 |
| UT | $174.90 | 1 |
| VA | $177.24–$205.93 | 2 |
| VI | $183.36 | 1 |
| VT | $175.71 | 1 |
| WA | $186.09–$207.46 | 2 |
| WI | $170.09 | 1 |
| WV | $173.48 | 1 |
| WY | $179.42 | 1 |
How the 56441 rate is calculated
Each of 56441’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 · 56441
RVUs × geographic indexes × conversion factor
Work1.97
1.97 RVUs× 1.000 GPCI
Practice expense3.15
3.15 RVUs× 1.000 GPCI
Malpractice0.34
0.34 RVUs× 1.000 GPCI
Adjusted RVUs
5.4600
Conversion factor
$33.4009
Medicare rate
$182.37
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Ohio inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
6,406
- Code
- 56441
- Physician work
- 1.97
- Practice expense
- 3.15
- Malpractice
- 0.34
GPCI2026.csv
85
- Locality
- Ohio
- Physician work
- 1.000
- Practice expense
- 0.913
- Malpractice
- 1.008
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.97 | × 1.000 | 1.9700 |
| Practice expense | 3.15 | × 0.913 | 2.8760 |
| Malpractice | 0.34 | × 1.008 | 0.3427 |
| Total RVUs | 5.1887 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Ohio$173.31
Office: (1.97 × 1 + 3.15 × 0.913 + 0.34 × 1.008) × $33.4009 = $173.31
Facility: (1.97 × 1 + 1.9 × 0.913 + 0.34 × 1.008) × $33.4009 = $135.19
Payment rules and modifiers for 56441
56441 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 56441
Labial adhesion lysis, labial adhesions
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| 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 · 56441
Labial adhesion lysis, labial adhesions
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
56441 without 51 · national office
$182.37
Labial adhesion lysis, labial adhesions
56441-51 · Second procedure: 50%
$91.19
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
How 56441 has changed in Ohio
56441 · Office / nonfacility
$173.31
Effective 2026-10-01
The base rate is $5.12 higher than on 2025-10-01, moving from $168.19 to $173.31 (3.0%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$168.19changed to$173.31
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 2.02 changed to 1.97
- Malpractice RVU 0.30 changed to 0.34
- Practice expense GPCI 0.911 changed to 0.913
- Malpractice GPCI 1.033 changed to 1.008
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$175.89changed to$168.19
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 3.22 changed to 3.15
- Malpractice RVU 0.32 changed to 0.30
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$173.02changed to$175.89
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$178.46changed to$173.02
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 3.21 changed to 3.22
- Malpractice RVU 0.30 changed to 0.32
- Practice expense GPCI 0.912 changed to 0.911
- Malpractice GPCI 1.063 changed to 1.033
January 1, 2023
RVU23A
$183.06changed to$178.46
- Conversion factor 34.6062 changed to 33.8872
- Malpractice RVU 0.31 changed to 0.30
- Practice expense GPCI 0.913 changed to 0.912
- Malpractice GPCI 1.094 changed to 1.063
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$174.96changed to$183.06
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 2.92 changed to 3.21
- Malpractice RVU 0.30 changed to 0.31
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$163.41changed to$174.96
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 2.42 changed to 2.92
- Malpractice RVU 0.28 changed to 0.30
- Practice expense GPCI 0.915 changed to 0.913
- Malpractice GPCI 1.049 changed to 1.094
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$149.93changed to$163.41
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 2.06 changed to 2.42
- Malpractice RVU 0.25 changed to 0.28
- Practice expense GPCI 0.917 changed to 0.915
- Malpractice GPCI 1.005 changed to 1.049
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$142.80changed to$149.93
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 1.86 changed to 2.06
- Malpractice RVU 0.24 changed to 0.25
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$141.39changed to$142.80
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 1.83 changed to 1.86
- Practice expense GPCI 0.918 changed to 0.917
- Malpractice GPCI 0.999 changed to 1.005
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$140.68changed to$141.39
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 1.82 changed to 1.83
- Malpractice GPCI 0.993 changed to 0.999
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$142.92changed to$140.68
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 1.84 changed to 1.82
- Malpractice RVU 0.27 changed to 0.24
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$142.20changed to$142.92
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$143.08changed to$142.20
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 1.80 changed to 1.84
- Malpractice RVU 0.28 changed to 0.27
- Practice expense GPCI 0.923 changed to 0.918
- Malpractice GPCI 1.117 changed to 0.993
Held through RVU15B.
January 1, 2014
RVU14A
$143.09changed to$143.08
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 1.97 changed to 1.80
- Malpractice RVU 0.29 changed to 0.28
- Practice expense GPCI 0.927 changed to 0.923
- Malpractice GPCI 1.240 changed to 1.117
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $143.09
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $173.31 | $135.19 | RVU26D |
| 2026-07-01 | $173.31 | $135.19 | RVU26C |
| 2026-04-01 | $173.31 | $135.19 | RVU26B |
| 2026-01-01 | $173.31 | $135.19 | RVU26A |
| 2025-10-01 | $168.19 | $144.91 | RVU25D |
| 2025-07-01 | $168.19 | $144.91 | RVU25C |
| 2025-04-01 | $168.19 | $144.91 | RVU25B |
| 2025-01-01 | $168.19 | $144.91 | RVU25A |
| 2024-10-01 | $175.89 | $150.11 | RVU24D |
| 2024-07-01 | $175.89 | $150.11 | RVU24C |
| 2024-04-01 | $175.89 | $150.11 | RVU24B |
| 2024-03-09 | $175.89 | $150.11 | RVU24AR |
| 2024-01-01 | $173.02 | $147.66 | RVU24A |
| 2023-10-01 | $178.46 | $151.27 | RVU23D |
| 2023-07-01 | $178.46 | $151.27 | RVU23C |
| 2023-04-01 | $178.46 | $151.27 | RVU23B |
| 2023-01-01 | $178.46 | $151.27 | RVU23A |
| 2022-10-01 | $183.06 | $153.68 | RVU22D |
| 2022-07-01 | $183.06 | $153.68 | RVU22C |
| 2022-04-01 | $183.06 | $153.68 | RVU22B |
| 2022-01-01 | $183.06 | $153.68 | RVU22A |
| 2021-10-01 | $174.96 | $150.75 | RVU21D |
| 2021-07-01 | $174.96 | $150.75 | RVU21C |
| 2021-04-01 | $174.96 | $150.75 | RVU21B |
| 2021-01-01 | $174.96 | $150.75 | RVU21A |
| 2020-10-01 | $163.41 | $147.56 | RVU20D |
| 2020-07-01 | $163.41 | $147.56 | RVU20C |
| 2020-04-01 | $163.41 | $147.56 | RVU20B |
| 2020-01-01 | $163.41 | $147.56 | RVU20A |
| 2019-10-01 | $149.93 | $142.00 | RVU19D |
| 2019-07-01 | $149.93 | $142.00 | RVU19C |
| 2019-04-01 | $149.93 | $142.00 | RVU19B |
| 2019-01-01 | $149.93 | $142.00 | RVU19A |
| 2018-10-01 | $142.80 | $137.19 | RVU18D |
| 2018-07-01 | $142.80 | $137.19 | RVU18C |
| 2018-04-01 | $142.80 | $137.19 | RVU18B |
| 2018-01-01 | $142.80 | $137.19 | RVU18AR1 |
| 2017-10-01 | $141.39 | $136.78 | RVU17D |
| 2017-07-01 | $141.39 | $136.78 | RVU17C |
| 2017-04-01 | $141.39 | $136.78 | RVU17B |
| 2017-01-01 | $141.39 | $136.78 | RVU17A |
| 2016-10-01 | $140.68 | $135.75 | RVU16D |
| 2016-07-01 | $140.68 | $135.75 | RVU16C |
| 2016-04-01 | $140.68 | $135.75 | RVU16B |
| 2016-01-01 | $140.68 | $135.75 | RVU16A |
| 2015-10-01 | $142.92 | $137.97 | RVU15D |
| 2015-07-01 | $142.92 | $137.97 | RVU15C |
| 2015-04-01 | $142.20 | $137.28 | RVU15B |
| 2015-01-01 | $142.20 | $137.28 | RVU15A |
| 2014-10-01 | $143.08 | $138.78 | RVU14D |
| 2014-07-01 | $143.08 | $138.78 | RVU14C |
| 2014-04-01 | $143.08 | $138.78 | RVU14B |
| 2014-01-01 | $143.08 | $138.78 | RVU14A |
| 2013-10-01 | $143.09 | $138.05 | RVU13D |
| 2013-07-01 | $143.09 | $138.05 | RVU13C |
| 2013-04-01 | $143.09 | $138.05 | RVU13B |
| 2013-01-01 | $143.09 | $138.05 | RVU13AR |
Where the Ohio rate applies
Ohio is a Medicare payment area, not a city. Our Census mapping connects it to 1265 cities and communities in Ohio. Some span more than one payment area; confirm with the service ZIP.
- Aberdeen
- Ada
- Adamsville
- Addyston
- Adelphi
- Adena
- Ai
- Akron
56441 billing questions
When should 56441 be selected instead of 56442?
Use 56441 for separating labial adhesions. Code 56442 describes a procedure involving the hymen, not fused labial tissue.
Does the 10-day global period include follow-up visits?
Related postoperative visits during the 10-day global period are included in 56441.
Can modifier 50 be used for adhesions on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; do not append modifier 50.
How does a same-session procedure affect payment?
When other procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard multiple-procedure reduction.
What documentation supports reporting 56441?
Document the labial adhesion, why procedural separation was indicated, and the lysis performed. An evaluation or treatment recommendation without lysis does not support this procedure code.
Can an assistant or another surgeon be reported?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons and team surgery are not permitted for this code.
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
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