Billing code 56805: ClitoroplastyMedicare rate & RVUs in Delaware
Surgical clitoral reconstruction for an intersex state, reported when the surgeon performs the specific clitoral procedure rather than a separate vaginal or introital repair.
CMS doesn’t publish an office rate for 56805 in Delaware.
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 9 sections
What 56805 covers
This code describes clitoral reconstruction performed as part of surgical care for an intersex state. A surgeon addresses the clitoris and surrounding anatomy in an operating room, commonly in a hospital setting. The service may be performed by a surgeon specializing in pediatric or adult urology, gynecology, or genital reconstruction. The operative report should identify the relevant anatomy, the condition being treated, and the clitoral work performed.
Report the code when the documented procedure matches clitoroplasty for an intersex state; a separate introital repair or vaginal reconstruction has its own coding considerations. The code has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. An assistant at surgery may be paid. 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.
56805 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | Unavailable | $1,012.71 |
How the 56805 rate is calculated
Each of 56805’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 · 56805
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 19.38Practice expense 7.89Malpractice 3.39
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 56805
56805 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 56805
Clitoroplasty
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 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) | 0.12/0.74/0.14 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 56805
Clitoroplasty
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
56805 without 51 · national facility
$1,024.07
Clitoroplasty
56805-51 · Second procedure: 50%
$512.04
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%).
56805 compared with similar codes
Compare codes
56805 vs 57335 vs 56800 vs 56810: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 57335Vaginal repair
- This code is for clitoral reconstruction in an intersex state. Code 57335 addresses vaginal reconstruction for an intersex state.
- 56800Introital repair
- Code 56800 describes repair of the vaginal opening. It is not a substitute for clitoral reconstruction.
- 56810Perineoplasty
- Code 56810 describes nonobstetric perineal repair. Choose it for distinct perineal work, not for the clitoral procedure itself.
56805 billing questions
How is clitoroplasty distinguished from an introital repair?
This code represents clitoral reconstruction for an intersex state. Code an introital repair separately only when that distinct repair is performed and documented.
How does this differ from vaginal reconstruction for an intersex state?
Clitoroplasty addresses the clitoris; vaginal reconstruction addresses the creation or reconstruction of the vagina. If both distinct procedures are performed, document each separately.
What documentation supports reporting this code?
The operative report should describe the intersex-state indication, the anatomy treated, and the clitoral procedure performed. Include enough detail to distinguish it from any separately performed vaginal or introital work.
Can an assistant surgeon be reported?
Assistant-at-surgery payment may be available for this procedure. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What is included in the global period?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
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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