CPT code 56800: Introital repair, plastic repair2026 Medicare rate & RVUs in Washington, DC area

In Washington, DC area, Medicare pays $250.26 for 56800 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 56800 nationwide

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

What 56800 covers

CPT 56800 covers surgical reshaping or reconstruction of the vaginal opening. A gynecologic surgeon may perform it when the introitus is narrowed, scarred, or distorted and requires plastic repair. The operative record should identify the affected anatomy, the reason for repair, and the work performed. This is distinct from a repair focused on the perineal body or a procedure directed at labial adhesions or hymenal tissue.

Report the code for the introital repair performed, not simply because the operative site is near the vaginal opening. Related postoperative visits during the 10-day global period are included. When multiple procedures are performed in the same session, Medicare pays the highest-valued procedure in full and reduces the others by 50%. Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; co-surgeons are paid only with 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.

How Washington, DC area compares for 56800

Across 109 of 109 payment localities, the facility rate for 56800 runs from $205.56 in Arkansas to $286.21 in Alaska. Washington, DC area pays $250.26. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

56800 rates by state

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

See 56800 in every payment locality

How the 56800 rate is calculated

Each of 56800’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.

Payment rules and modifiers for 56800

56800 has a 10-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

Codes related to 56800

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

How 56800 has changed in Washington, DC area

Price 56800 for an earlier date of service

Where the Washington, DC area rate applies

Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.

• Washington

Browse all communities in District of Columbia

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

Open CMS sourceHow we calculate rates