No office rate
57107 describes complete vaginal-wall removal. Use 57109 when the operation is radical and includes bilateral total pelvic lymphadenectomy.
On this page
CMS RVU26D · Effective 2026-10-01
57109 Radical vaginectomy Medicare reimbursement rates
Report radical vaginectomy with bilateral pelvic lymphadenectomy for definitive surgical treatment of selected vaginal malignancies requiring this extent of resection. Compare 57109 office and facility rates across CMS payment localities.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 57109?
The service location and office or facility setting determine which base rate applies. These are the supported base rates for the 109 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 57109 pays more and less
Gynecologic surgery
About 57109: Radical vaginectomy with pelvic lymphadenectomy
Report radical vaginectomy with bilateral pelvic lymphadenectomy for definitive surgical treatment of selected vaginal malignancies requiring this extent of resection.
This operation removes the vagina radically for selected vaginal malignancies and includes bilateral total pelvic lymphadenectomy. A gynecologic oncologist typically performs it in an operating room, removing the vaginal disease and regional pelvic nodes as part of definitive cancer surgery; the resection depends on tumor extent and the operative plan.
Report 57109 when the operation meets the radical vaginectomy service with the included bilateral pelvic node dissection, not for a limited vaginal-wall excision or diagnostic biopsy. The operative report should establish the radical extent and document pelvic lymphadenectomy, with pathology and diagnosis supporting the cancer operation. The code is priced bilaterally, so modifier 50 does not increase payment. It has a 90-day global period that includes the day-before preoperative visit and related postoperative care. For other procedures in the same session, the highest-valued procedure is paid in full and additional procedures at 50%. Assistant-at-surgery payment may be made, co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 57109
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- The code is already priced as bilateral; modifier 50 does not increase payment.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU27.69 · 57%
- Practice expense (office) RVU14.54 · 30%
- Malpractice RVU6.42 · 13%
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.
57109 compared with similar codes
Office rate ranges across all CMS payment localities, from the same CMS release.
No office rate
57111 includes removal of paravaginal tissue with complete vaginal-wall removal. 57109 is the radical service with bilateral pelvic lymphadenectomy.
$93.36–$132.09
57100 is a simple vaginal mucosal biopsy for tissue sampling. 57109 is a radical cancer operation with bilateral pelvic lymphadenectomy.
See how rates vary across the country
57109 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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 all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Compare 57109 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | Office Unavailable | Facility $1471.18 |
| Alaska* | Office Unavailable | Facility $2022.68 |
| Arizona | Office Unavailable | Facility $1579.02 |
| Arkansas | Office Unavailable | Facility $1452.48 |
| Atlanta | Office Unavailable | Facility $1678.60 |
| Austin | Office Unavailable | Facility $1630.53 |
| Bakersfield | Office Unavailable | Facility $1605.31 |
| Baltimore/Surr. Cntys | Office Unavailable | Facility $1726.02 |
| Beaumont | Office Unavailable | Facility $1566.02 |
| Brazoria | Office Unavailable | Facility $1580.81 |
| Chicago | Office Unavailable | Facility $1911.55 |
| Chico | Office Unavailable | Facility $1587.80 |
| Colorado | Office Unavailable | Facility $1620.17 |
| Connecticut | Office Unavailable | Facility $1725.88 |
| Dallas | Office Unavailable | Facility $1600.89 |
| Dc + Md/Va Suburbs | Office Unavailable | Facility $1785.57 |
| Delaware | Office Unavailable | Facility $1602.09 |
| Detroit | Office Unavailable | Facility $1755.06 |
| East St. Louis | Office Unavailable | Facility $1803.54 |
| El Centro | Office Unavailable | Facility $1588.87 |
| Fort Lauderdale | Office Unavailable | Facility $1804.53 |
| Fort Worth | Office Unavailable | Facility $1598.82 |
| Fresno | Office Unavailable | Facility $1587.80 |
| Galveston | Office Unavailable | Facility $1592.07 |
| Hanford-Corcoran | Office Unavailable | Facility $1587.80 |
| Hawaii, Guam | Office Unavailable | Facility $1601.21 |
| Houston | Office Unavailable | Facility $1709.58 |
| Idaho | Office Unavailable | Facility $1473.10 |
| Indiana | Office Unavailable | Facility $1479.28 |
| Iowa | Office Unavailable | Facility $1454.37 |
| Kansas | Office Unavailable | Facility $1471.97 |
| Kentucky | Office Unavailable | Facility $1552.82 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $1679.70 |
| Madera | Office Unavailable | Facility $1587.80 |
| Manhattan | Office Unavailable | Facility $1888.48 |
| Merced | Office Unavailable | Facility $1587.80 |
| Metropolitan Boston | Office Unavailable | Facility $1733.50 |
| Metropolitan Kansas City | Office Unavailable | Facility $1590.40 |
| Metropolitan Philadelphia | Office Unavailable | Facility $1702.90 |
| Metropolitan St. Louis | Office Unavailable | Facility $1602.07 |
| Miami | Office Unavailable | Facility $1972.73 |
| Minnesota | Office Unavailable | Facility $1488.08 |
| Mississippi | Office Unavailable | Facility $1501.48 |
| Modesto | Office Unavailable | Facility $1587.80 |
| Montana** | Office Unavailable | Facility $1624.52 |
| Napa | Office Unavailable | Facility $1732.16 |
| Nebraska | Office Unavailable | Facility $1454.18 |
| Nevada** | Office Unavailable | Facility $1589.63 |
| New Hampshire | Office Unavailable | Facility $1618.06 |
| New Mexico | Office Unavailable | Facility $1627.75 |
| New Orleans | Office Unavailable | Facility $1625.46 |
| North Carolina | Office Unavailable | Facility $1515.00 |
| North Dakota** | Office Unavailable | Facility $1497.58 |
| Northern Nj | Office Unavailable | Facility $1775.51 |
| Nyc Suburbs/Long Island | Office Unavailable | Facility $1959.70 |
| Ohio | Office Unavailable | Facility $1584.42 |
| Oklahoma | Office Unavailable | Facility $1525.17 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $1658.40 |
| Portland | Office Unavailable | Facility $1638.76 |
| Poughkpsie/N Nyc Suburbs | Office Unavailable | Facility $1757.74 |
| Puerto Rico | Office Unavailable | Facility $1627.08 |
| Queens | Office Unavailable | Facility $1867.31 |
| Redding | Office Unavailable | Facility $1587.80 |
| Rest Of California | Office Unavailable | Facility $1587.80 |
| Rest Of Florida | Office Unavailable | Facility $1711.45 |
| Rest Of Georgia | Office Unavailable | Facility $1613.67 |
| Rest Of Illinois | Office Unavailable | Facility $1703.43 |
| Rest Of Louisiana | Office Unavailable | Facility $1560.10 |
| Rest Of Maine | Office Unavailable | Facility $1505.05 |
| Rest Of Maryland | Office Unavailable | Facility $1622.45 |
| Rest Of Massachusetts | Office Unavailable | Facility $1621.96 |
| Rest Of Michigan | Office Unavailable | Facility $1610.36 |
| Rest Of Missouri | Office Unavailable | Facility $1552.36 |
| Rest Of New Jersey | Office Unavailable | Facility $1727.43 |
| Rest Of New York | Office Unavailable | Facility $1536.98 |
| Rest Of Oregon | Office Unavailable | Facility $1559.32 |
| Rest Of Pennsylvania | Office Unavailable | Facility $1573.34 |
| Rest Of Texas | Office Unavailable | Facility $1579.39 |
| Rest Of Washington | Office Unavailable | Facility $1611.47 |
| Rhode Island | Office Unavailable | Facility $1635.39 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $1656.70 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $1637.91 |
| Salinas | Office Unavailable | Facility $1631.35 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $1649.68 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $1795.92 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $1788.63 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $1841.85 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $1812.04 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $1608.68 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $1649.29 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $1631.97 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $1663.93 |
| Seattle (King Cnty) | Office Unavailable | Facility $1742.20 |
| South Carolina | Office Unavailable | Facility $1555.88 |
| South Dakota** | Office Unavailable | Facility $1482.57 |
| Southern Maine | Office Unavailable | Facility $1541.46 |
| Stockton | Office Unavailable | Facility $1587.80 |
| Suburban Chicago | Office Unavailable | Facility $1810.08 |
| Tennessee | Office Unavailable | Facility $1481.48 |
| Utah | Office Unavailable | Facility $1573.94 |
| Vallejo | Office Unavailable | Facility $1721.65 |
| Vermont | Office Unavailable | Facility $1514.17 |
| Virgin Islands | Office Unavailable | Facility $1627.08 |
| Virginia | Office Unavailable | Facility $1553.65 |
| Visalia | Office Unavailable | Facility $1587.80 |
| West Virginia | Office Unavailable | Facility $1653.75 |
| Wisconsin | Office Unavailable | Facility $1456.17 |
| Wyoming** | Office Unavailable | Facility $1569.20 |
| Yuba City | Office Unavailable | Facility $1587.80 |
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57109 billing questions
When should 57109 be chosen over a complete vaginectomy code?
Use 57109 for radical vaginectomy with bilateral total pelvic lymphadenectomy. A complete vaginal-wall excision without that radical service and nodal dissection is described by a different code.
Should modifier 50 be appended?
The service is already priced as bilateral, so modifier 50 does not increase payment.
What documentation supports reporting 57109?
The operative report should describe the radical vaginal resection and bilateral pelvic lymphadenectomy. The diagnosis and pathology should support the cancer operation.
How does the global period affect related care?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How are other same-session procedures handled?
The highest-valued procedure is paid in full and other procedures are paid at 50%. Assistant-at-surgery payment may be made; co-surgeons need supporting documentation, and 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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
6,43657105,,Biopsy vaginal mucosa xtnsv,A,,1.70,3.22,,2.03,,0.33,5.25,4.06,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,43757106,,Vagnc prtl rmvl vag wall,A,,7.31,6.08,NA,6.08,,1.35,14.74,14.74,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,43857107,,Vagnc compl rmvl paravag tis,A,,23.95,10.91,NA,10.91,,4.69,39.55,39.55,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,43957109,,Vagnc bi total pel lymphadec,A,,27.69,14.54,NA,14.54,,6.42,48.65,48.65,0,090,0.12,0.74,0.14,2,2,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,44057110,,Vagnc compl rmvl vag wall,A,,15.09,6.25,NA,6.25,,2.55,23.89,23.89,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,44157111,,Vagnc compl rmvl paravag tis,A,,27.69,14.54,NA,14.54,,6.42,48.65,48.65,0,090,0.12,0.74,0.14,2,2,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,44257120,,Colpocleisis le fort type,A,,8.07,4.78,NA,4.78,,1.33,14.18,14.18,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00