No office rate
This code is for clitoral reconstruction in an intersex state. Code 57335 addresses vaginal reconstruction for an intersex state.
On this page
CMS RVU26D · Effective 2026-10-01
56805 Clitoroplasty Medicare reimbursement rates in Massachusetts
Surgical clitoral reconstruction for an intersex state, reported when the surgeon performs the specific clitoral procedure rather than a separate vaginal or introital repair. Compare 56805 office and facility rates across CMS payment localities in Massachusetts.
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 56805 in Massachusetts?
Massachusetts has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1025.41–$1089.28
2 of 2 localities have a 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.
Genital reconstructive surgery
About 56805: Clitoral reconstruction for intersex state
Surgical clitoral reconstruction for an intersex state, reported when the surgeon performs the specific clitoral procedure rather than a separate vaginal or introital repair.
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.
CMS billing rules for 56805
- 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
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- 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 RVU19.38 · 63%
- Practice expense (office) RVU7.89 · 26%
- Malpractice RVU3.39 · 11%
100
Medicare services in 2024 · #4885 by national volume
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 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
No office rate
Code 56800 describes repair of the vaginal opening. It is not a substitute for clitoral reconstruction.
No office rate
Code 56810 describes nonobstetric perineal repair. Choose it for distinct perineal work, not for the clitoral procedure itself.
Compare 56805 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.
2 of 2 payment localities
Metropolitan Boston →
Office / nonfacility
Unavailable
Facility
$1089.28
Rest Of Massachusetts →
Office / nonfacility
Unavailable
Facility
$1025.41
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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 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.
6,42156700,,Prtl hymnctmy/revj hymnl rng,A,,2.77,2.19,NA,2.19,,0.48,5.44,5.44,0,010,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,42256740,,Exc bartholins gland/cyst,A,,4.76,2.84,NA,2.84,,0.87,8.47,8.47,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,42356800,,Plastic repair introitus,A,,3.83,2.31,NA,2.31,,0.66,6.80,6.80,0,010,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,42456805,,Clitoroplasty intersex state,A,,19.38,7.89,NA,7.89,,3.39,30.66,30.66,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,42556810,,Perineoplasty rpr per nonob,A,,4.18,2.33,NA,2.33,,0.71,7.22,7.22,0,010,0.10,0.80,0.10,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,42656820,,Colposcopy vulva,A,,1.46,2.10,,0.53,,0.27,3.83,2.26,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,42756821,,Colposcopy vulva w/biopsy,A,,2.00,2.74,,0.65,,0.38,5.12,3.03,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00