CPT code 56640: Radical vulvectomy, complete with pelvic dissection2026 Medicare rate & RVUs in Missouri
Reports complete radical removal of the vulva with bilateral inguinofemoral and pelvic lymph node dissection, typically for invasive vulvar malignancy.
CMS doesn’t publish an office rate for 56640 in Missouri.
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 56640 covers
This operation removes the vulva in its entirety as a radical cancer procedure and includes bilateral inguinofemoral lymphadenectomy and pelvic lymph node dissection. It is generally performed by a gynecologic oncologist in a hospital or other surgical facility for selected patients with invasive vulvar cancer when the operative plan includes this extent of nodal surgery. The groin and pelvic node work is part of the service represented by this code.
Select this code when the operative report supports complete radical vulvar removal and both the bilateral inguinofemoral and pelvic node dissections; a partial resection or a procedure without pelvic node dissection points to a different code in the family. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and the others at 50%. A qualifying bilateral service reported with modifier 50 is paid at 150%. Assistant-at-surgery payment may be allowed; co-surgeon payment requires supporting documentation, and team surgery is 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 56640 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | $1,401.18 |
| Metropolitan St. Louis, MO | Unavailable | $1,411.55 |
| Rest of Missouri | Unavailable | $1,366.86 |
How the 56640 rate is calculated
Each of 56640’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 · 56640
RVUs × geographic indexes × conversion factor
Work24.16
24.16 RVUs× 1.000 GPCI
Practice expense13.13
13.13 RVUs× 1.000 GPCI
Malpractice5.59
5.59 RVUs× 1.000 GPCI
Adjusted RVUs
42.8800
Conversion factor
$33.4009
Medicare rate
$1,432.23
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 56640
56640 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 56640
Radical vulvectomy, complete with pelvic dissection
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.12/0.74/0.14 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 56640
Radical vulvectomy, complete with pelvic dissection
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
56640 without 50 · national facility
$1,432.23
Radical vulvectomy, complete with pelvic dissection
56640-50 · Bilateral: 150%
$2,148.35
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
56640 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 56637Radical vulvectomyComplete, bilateral nodes
- Both include complete radical vulvectomy and bilateral inguinofemoral lymphadenectomy. Choose 56640 when pelvic lymph node dissection is also performed as part of the operation.
- 56634Radical vulvectomyComplete, unilateral node dissection
- 56634 covers complete radical vulvectomy with unilateral inguinofemoral lymphadenectomy. It does not represent the bilateral groin and pelvic node dissection included in 56640.
- 56633VulvectomyRadical, complete
- 56633 represents complete radical vulvectomy without the lymphadenectomy components. Use 56640 when the documented operation also includes bilateral inguinofemoral and pelvic node dissection.
56640 billing questions
How does 56640 differ from 56637?
56640 includes pelvic lymph node dissection in addition to complete radical vulvectomy and bilateral inguinofemoral lymphadenectomy. Use 56637 when the operative service includes the bilateral groin node dissection but not pelvic node dissection.
Are the groin and pelvic node dissections separately reported?
They are included in 56640 when performed as part of the coded operation. The operative report should document the extent and laterality of the node dissections.
When should 56633 be used instead?
56633 describes complete radical vulvectomy without the inguinofemoral lymphadenectomy included in 56640. The documented operation, rather than the cancer diagnosis alone, determines the appropriate code.
What documentation supports 56640?
Document that the vulvar removal was complete and radical, and describe bilateral inguinofemoral and pelvic lymph node dissection. Include the operative findings and the extent of each surgical component.
How does Medicare handle other procedures performed in the same session?
Medicare pays the highest-valued procedure in full and other procedures at 50%. Related postoperative care for 56640 falls within its 90-day global period.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be allowed. Co-surgeon payment requires supporting documentation, while team surgery is not permitted.
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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