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CPT code 56442: Hymenotomy, hymenal opening incision2026 Medicare rate & RVUs

Hymenotomy opens obstructing hymenal tissue, commonly to relieve menstrual outflow obstruction from an imperforate hymen.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $43.76 for 56442 nationally in a facility.

Medicare rate · 56442

Hymenotomy, hymenal opening incision

Office or facility?

Work RVUs
0.66
Total RVUs
1.31
Global days
000

National rate · 2026

$43.76

Facility setting, before claim adjustments.

See every locality for 56442 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 56442 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 56442 covers

A gynecologist performs a hymenotomy by incising hymenal tissue to create an opening, most often when an imperforate hymen obstructs menstrual outflow. Patients may present with cyclic pelvic pain or retained menstrual fluid; the procedure may be performed in an office or outpatient surgical setting, depending on the clinical situation and anesthesia needs.

Report 56442 when the treated obstruction is at the hymen, rather than the labia or vaginal canal. The record should identify the hymenal abnormality, the resulting symptoms or obstruction, and the incision performed. The 0-day global period includes same-day preoperative and postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and the others are subject to the standard 50% 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.

Where 56442 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

56442 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$39.80
AlaskaUnavailable$54.13
ArizonaUnavailable$42.63
ArkansasUnavailable$39.32
Atlanta, GAUnavailable$44.91
Austin, TXUnavailable$44.37
Bakersfield, CAUnavailable$44.31
Baltimore area, MDUnavailable$46.35
Beaumont, TXUnavailable$41.88
Brazoria, TXUnavailable$42.89

56442 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
56442 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 56442 rate is calculated

Each of 56442’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 · 56442

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.66

0.66 RVUs× 1.000 GPCI

Practice expense0.53

0.53 RVUs× 1.000 GPCI

Malpractice0.12

0.12 RVUs× 1.000 GPCI

Adjusted RVUs

1.3100

Conversion factor

$33.4009

Medicare rate

$43.76

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 56442

The CMS indicators that decide how 56442 is paid alongside other services.

CMS payment indicators · 56442

Hymenotomy, hymenal opening incision

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

56442 without 51 · national facility

$43.76

Hymenotomy, hymenal opening incision

56442-51 · Second procedure: 50%

$21.88

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%).

When to use modifier 51

56442 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 56442

    Hymenotomy, hymenal opening incision0.66 wRVU

    Not priced

  • 56441

    Labial adhesion lysis, labial adhesions1.97 wRVU

    $182.37

  • 56700

    Hymenal surgery, partial excision or ring revision2.77 wRVU

    Not priced

  • 56405

    Abscess drainage, vulva or perineum1.45 wRVU

    $145.96

  • 56420

    Abscess drainage, bartholin gland1.4 wRVU

    $182.03

How to choose

56441Labial adhesion lysisLabial adhesions
Use 56442 for an incision of obstructing hymenal tissue. Use 56441 when the procedure divides labial adhesions.
56700Hymenal surgeryPartial excision or ring revision
Use 56700 when an obstructing vaginal septum is excised; 56442 addresses obstruction at the hymen.
56405Abscess drainageVulva or perineum
56405 is for drainage of a vulvar or perineal abscess, not opening hymenal tissue.
56420Abscess drainageBartholin gland
56420 addresses drainage of a Bartholin gland abscess; 56442 is selected for hymenal obstruction.

Codes related to 56442

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 56442
CodeHow it relatesNational office range
Used instead
56441Labial adhesion lysis, labial adhesionsTreats introital obstruction caused by labial adhesions rather than hymenal tissue.$162.03–$230.84
56700Hymenal surgery, partial excision or ring revisionAddresses obstruction caused by a vaginal septum rather than the hymen.No office rate
Often billed with
00952Hysteroscopy anesthesia, hysteroscopy or tubal imagingAnesthesia for vaginal procedures may be reported with a hymenotomy performed under anesthesia.No office rate

56442 billing questions

When should 56442 be selected instead of lysis of labial adhesions?

Use 56442 when the obstructing tissue is the hymen. Use 56441 when labial adhesions are the tissue being divided.

What documentation supports reporting a hymenotomy?

Document the hymenal abnormality, the symptoms or outflow obstruction it causes, and the incision performed to open the hymen.

Is same-day evaluation and follow-up included?

Yes. The 0-day global period includes same-day preoperative and postoperative care.

How does Medicare handle other procedures performed in the same session?

The highest-valued procedure is paid in full; other procedures in the session are subject to the standard multiple-procedure reduction.

Can modifier 50 or an assistant-at-surgery claim be used?

Modifier 50 is inappropriate for this code. Assistant-at-surgery payment is allowed only when medical necessity is documented.

Can co-surgeons or a surgical team report this procedure?

No. CMS does not permit co-surgeons or team surgery 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
RVUs for 56442PPRRVU2026_Oct_nonQPP.csv, line 6,407 (RVU26D)

Open CMS sourceHow we calculate rates

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