CPT code 56442: Hymenotomy, hymenal opening incision2026 Medicare rate & RVUs in Florida
Hymenotomy opens obstructing hymenal tissue, commonly to relieve menstrual outflow obstruction from an imperforate hymen.
CMS doesn’t publish an office rate for 56442 in Florida.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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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 in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale, FL | Unavailable | $47.22 |
| Miami, FL | Unavailable | $50.61 |
| Rest of Florida | Unavailable | $44.99 |
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
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is 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. |
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%).
56442 compared with similar codes
Compare codes · National
5 codes, side by side
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.
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
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