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Billing code 56800: Introital repairMedicare rate & RVUs

Reports surgical reshaping or reconstruction of the vaginal opening, typically to correct introital narrowing, scarring, or distortion.

CMS RVU26DEffective Oct 1, 2026109 payment localities149 Medicare services in 2024

Medicare pays $227.13 for 56800 nationally in a facility.

Medicare rate · 56800

Introital repair

Swap in your local Medicare rate.

Work RVUs
3.83
Total RVUs
6.80
Global days
010

National rate · 2026

$227.13

Facility setting, before claim adjustments.

See every locality for 56800 → · Billed by an NP, PA or therapist? →

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

On this page 10 sections
  1. Medicare rate
  2. What 56800 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 56800 covers

billing code 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

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

56800 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$207.91
Alaska*Unavailable$286.21
ArizonaUnavailable$221.56
ArkansasUnavailable$205.56
AtlantaUnavailable$233.18
AustinUnavailable$229.34
BakersfieldUnavailable$228.34
Baltimore/Surr. CntysUnavailable$240.03
BeaumontUnavailable$218.62
BrazoriaUnavailable$222.61

56800 rates by state

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

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Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
56800 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

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

Swap in your local Medicare rate.

Work 3.83Practice expense 2.31Malpractice 0.66

6.8000 adjusted RVUs×$33.4009 conversion factor=$227.13

All indexes start 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

RuleCMS valueWhat it means
Global period010Minor procedure: the day of the procedure plus 10 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.80/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 56800

Introital 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.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

56800 without 51 · national facility

$227.13

Introital 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%).

When to use modifier 51

56800 compared with similar codes

Compare codes

56800 vs 56810 vs 56441 vs 56700: national Medicare rates

Swap in your local Medicare rate.

  • 56800
    Introital repair · 3.83 wRVU
    —
  • 56810
    Perineoplasty · 4.18 wRVU
    —
  • 56441
    Labial adhesion lysis · 1.97 wRVU
    $182.37
  • 56700
    Hymenal surgery · 2.77 wRVU
    —

How to choose

56810Perineoplasty
56800 repairs the vaginal opening; 56810 is for nonobstetrical perineoplasty focused on the perineum or perineal body.
56441Labial adhesion lysis
56441 releases labial adhesions. Use 56800 when the documented procedure is plastic repair of the introitus, not simply separation of fused labia.
56700Hymenal surgery
56700 is hymenotomy for an obstructing hymen. It is not the code for reconstructive repair of the vaginal opening.

Codes related to 56800

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

Codes related to 56800
CodeHow it relatesNational office range
Used instead
56810PerineoplastyUse when the operative repair is focused on the perineal body rather than the vaginal opening.No office rate
56441Labial adhesion lysisAddresses lysis of labial adhesions rather than plastic reconstruction of the introitus.$162.03–$230.84
56700Hymenal surgeryAddresses hymenal obstruction with hymenotomy rather than introital plastic repair.No office rate

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
RVUs for 56800PPRRVU2026_Oct_nonQPP.csv, line 6,423 (RVU26D)

Open CMS sourceHow we calculate rates

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