CPT code 57156: Brachytherapy insertion, vaginal afterloading apparatus2026 Medicare rate & RVUs in Guam
Report this service when a clinician inserts a vaginal afterloading applicator to prepare for intracavitary brachytherapy, such as treatment of a vaginal cuff.
Medicare pays $238.54 for 57156 in the office in Guam (Hawaii, Guam, HI). Which amount applies depends on the service address.
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 57156 covers
A radiation oncologist or gynecologic oncologist places an afterloading applicator in the vagina to prepare for intracavitary brachytherapy. A vaginal cylinder is a common example, including for treatment directed to the vaginal cuff after hysterectomy for endometrial cancer. The service involves positioning the applicator for the planned treatment, rather than excision or treatment of a vaginal lesion.
Report the insertion when the record supports placement of a vaginal brachytherapy apparatus; document the indication and the applicator placed. The code has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this service. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted. Radiation delivery is a distinct service when performed and may be reported separately with the applicable delivery code.
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.
57156 in Hawaii, Guam, HI
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam, HI | $238.54 | $128.41 |
How the 57156 rate is calculated
Each of 57156’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 · 57156
RVUs × geographic indexes × conversion factor
Work2.62
2.62 RVUs× 1.000 GPCI
Practice expense3.87
3.87 RVUs× 1.000 GPCI
Malpractice0.21
0.21 RVUs× 1.000 GPCI
Adjusted RVUs
6.7000
Conversion factor
$33.4009
Medicare rate
$223.79
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 57156
The CMS indicators that decide how 57156 is paid alongside other services.
CMS payment indicators · 57156
Brachytherapy insertion, vaginal afterloading apparatus
| 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
57156 without 51 · national office
$223.79
Brachytherapy insertion, vaginal afterloading apparatus
57156-51 · Second procedure: 50%
$111.90
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%).
57156 compared with similar codes
Compare codes · National
57156 vs 57155 vs 57160: Medicare rates
How to choose
- 57155Brachytherapy applicatorUterine tandem and vaginal ovoids
- Choose 57156 for insertion of a vaginal afterloading apparatus such as a vaginal cylinder. Choose 57155 when the applicator placement involves a uterine tandem and/or vaginal ovoids.
- 57160Pessary fittingIntravaginal support device
- 57160 is for fitting and inserting a pessary or other vaginal support device. It is not the code for placing an applicator to prepare for brachytherapy.
57156 billing questions
How does this differ from 57155?
57156 is for placing a vaginal afterloading apparatus, commonly a vaginal cylinder. 57155 describes placement of a uterine tandem and/or vaginal ovoids for brachytherapy.
Does this code include radiation delivery?
It reports applicator insertion, not the radiation delivery itself. Report a separately performed delivery service with the applicable brachytherapy delivery code.
Is modifier 50 appropriate when treatment is directed to both sides?
No. CMS identifies bilateral adjustment as inappropriate for this service, so do not use modifier 50.
What documentation supports reporting 57156?
Document the brachytherapy indication, the vaginal afterloading apparatus placed, and the placement performed. The record should distinguish this service from placement of a uterine tandem or vaginal ovoids.
Can an assistant or another surgeon be reported?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeon and team-surgery billing are 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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