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Billing code 57265: Vaginal prolapse repairMedicare rate & RVUs

Reports vaginal repair of both anterior and posterior wall prolapse with repair of an enterocele during the same operation.

CMS RVU26DEffective Oct 1, 2026109 payment localities5.3K Medicare services in 2024

Medicare pays $768.22 for 57265 nationally in a facility.

Medicare rate · 57265

Vaginal prolapse repair

Swap in your local Medicare rate.

Work RVUs
14.63
Total RVUs
23.00
Global days
090

National rate · 2026

$768.22

Facility setting, before claim adjustments.

See every locality for 57265 → · 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 57265 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 57265 covers

This vaginal operation repairs prolapse involving both the anterior and posterior vaginal walls and also repairs an enterocele, a peritoneal sac descending into the upper vagina. The anterior repair addresses defects such as a cystocele, while the posterior repair addresses posterior wall prolapse such as a rectocele. A gynecologist or urogynecologist typically performs the operation in a hospital or ambulatory surgical setting.

Report 57265 when the operative record supports repair of both vaginal compartments and an enterocele in the same operation; a combined repair without enterocele repair is distinguished by 57260. Documentation should identify the defects treated and describe the enterocele repair. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and the others at 50%. Assistant-at-surgery payment may be available; co-surgeon payment requires 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 57265 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

57265 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$707.68
Alaska*Unavailable$988.14
ArizonaUnavailable$750.19
ArkansasUnavailable$700.31
AtlantaUnavailable$789.48
AustinUnavailable$771.17
BakersfieldUnavailable$764.00
Baltimore/Surr. CntysUnavailable$810.03
BeaumontUnavailable$744.63
BrazoriaUnavailable$752.14

57265 rates by state

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

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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
57265 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 57265 rate is calculated

Each of 57265’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 · 57265

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 14.63Practice expense 5.89Malpractice 2.48

23.0000 adjusted RVUs×$33.4009 conversion factor=$768.22

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 57265

57265 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 57265

Vaginal prolapse repair

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 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)0.12/0.74/0.14Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 57265

Vaginal prolapse repair

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

57265 without 51 · national facility

$768.22

Vaginal prolapse repair

57265-51 · Second procedure: 50%

$384.11

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

57265 compared with similar codes

Compare codes

57265 vs 57260 vs 57268 vs 57240 vs 57250: national Medicare rates

Swap in your local Medicare rate.

  • 57265
    Vaginal prolapse repair · 14.63 wRVU
    —
  • 57260
    Combined vaginal repair · 12.92 wRVU
    —
  • 57268
    Enterocele repair · 7.38 wRVU
    —
  • 57240
    Anterior repair · 9.83 wRVU
    —
  • 57250
    Posterior repair · 9.83 wRVU
    —

How to choose

57260Combined vaginal repair
Both represent combined anterior and posterior vaginal wall repair. Choose 57265 when the operation also repairs an enterocele; choose 57260 when it does not.
57268Enterocele repair
57268 is for vaginal repair of an enterocele as a separate procedure. It does not represent the combined anterior and posterior repairs included in 57265.
57240Anterior repair
57240 represents anterior vaginal wall repair alone. It is not the combined anterior and posterior repair with enterocele repair represented by 57265.
57250Posterior repair
57250 represents posterior vaginal wall repair alone. Use 57265 when the operation repairs both vaginal compartments and an enterocele.

Codes related to 57265

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

Codes related to 57265
CodeHow it relatesNational office range
Same family
57260Combined vaginal repairCombined anterior and posterior repair without the enterocele repair included in 57265.No office rate
Add-on codes
57267Pelvic floor meshAdd-on code for mesh or other prosthesis insertion with pelvic floor repair.No office rate
Used instead
57268Enterocele repairVaginal enterocele repair when the combined anterior and posterior repair is not performed.No office rate
57240Anterior repairAnterior repair alone when posterior wall and enterocele repairs are not part of the operation.No office rate
57250Posterior repairPosterior repair alone when anterior wall and enterocele repairs are not part of the operation.No office rate

57265 billing questions

How does 57265 differ from 57260?

Use 57265 when the combined anterior and posterior vaginal wall repair also includes repair of an enterocele. Use 57260 for the combined repair without enterocele repair.

Can mesh placement be reported with 57265?

When mesh is used for pelvic floor repair, 57267 is the related add-on code. The operative documentation should support mesh placement and the repair site.

Can 57240 or 57250 also be reported for the same operation?

Those codes describe anterior or posterior repair individually. When both compartments and an enterocele are repaired as the combined operation, report 57265 rather than separately reporting the individual repairs.

What documentation supports 57265?

Document the anterior and posterior defects treated and the enterocele repair performed. The operative report should make clear that all three components were addressed.

How does the 90-day global period affect postoperative visits?

The global period includes the day-before preoperative visit and 90 days of related postoperative care. Those visits are included in the surgical global service.

How are assistant or co-surgeon services handled?

Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; 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 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 57265PPRRVU2026_Oct_nonQPP.csv, line 6,458 (RVU26D)

Open CMS sourceHow we calculate rates

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