CPT code 56800: Introital repair, plastic repair2026 Medicare rate & RVUs in Missouri
Reports surgical reshaping or reconstruction of the vaginal opening, typically to correct introital narrowing, scarring, or distortion.
CMS doesn’t publish an office rate for 56800 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 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.
Where 56800 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 | $221.91 |
| Metropolitan St. Louis, MO | Unavailable | $223.47 |
| Rest of Missouri | Unavailable | $215.91 |
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.
How the rate is built · 56800
RVUs × geographic indexes × conversion factor
Work3.83
3.83 RVUs× 1.000 GPCI
Practice expense2.31
2.31 RVUs× 1.000 GPCI
Malpractice0.66
0.66 RVUs× 1.000 GPCI
Adjusted RVUs
6.8000
Conversion factor
$33.4009
Medicare rate
$227.13
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 56800
56800 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 56800
Introital repair, plastic repair
| 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) | 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) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 56800
Introital repair, plastic repair
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
56800 without 51 · national facility
$227.13
Introital repair, plastic repair
56800-51 · Second procedure: 50%
$113.57
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%).
56800 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 56810PerineoplastyNonobstetric perineal repair
- 56800 repairs the vaginal opening; 56810 is for nonobstetrical perineoplasty focused on the perineum or perineal body.
- 56441Labial adhesion lysisLabial adhesions
- 56441 releases labial adhesions. Use 56800 when the documented procedure is plastic repair of the introitus, not simply separation of fused labia.
- 56700Hymenal surgeryPartial excision or ring revision
- 56700 is hymenotomy for an obstructing hymen. It is not the code for reconstructive repair of the vaginal opening.
56800 billing questions
When should I report 56800 rather than perineoplasty?
Report 56800 when the operative work plastically repairs the vaginal opening itself. A repair focused on the perineal body may fit 56810 instead.
Is lysis of labial adhesions the same service?
No. Lysis of labial adhesions addresses fused labial tissue; 56800 describes plastic repair of the introitus. Select the code that matches the documented anatomy and work.
Can I append modifier 50 for bilateral work?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
Are related postoperative visits separately payable during the global period?
Related postoperative visits during the 10-day global period are included in the procedure payment.
How are multiple procedures handled in the same session?
Medicare pays the highest-valued procedure in full and reduces the other procedures by 50%.
What documentation supports reporting 56800?
Document the indication, the specific introital anatomy involved, and the plastic repair performed. The record should distinguish this work from a perineal-body repair or lysis of labial adhesions.
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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