Billing code 57305: Fistula repairMedicare rate & RVUs in Oregon
Reports surgical closure of a rectum-to-vagina fistula through an abdominal approach, with code selection based on the operative route and associated procedures.
CMS doesn’t publish an office rate for 57305 in Oregon.
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 57305 covers
This service repairs an abnormal connection between the rectum and vagina using an abdominal approach. Patients may report stool or gas passing through the vagina. Gynecologic, urogynecologic, or colorectal surgeons may perform the operation in a hospital setting, particularly when the fistula’s location or associated pelvic disease requires abdominal access.
Select this code when the operative report supports abdominal access for the fistula repair; a vaginal or perineal route points to a different code. Document the fistula’s anatomy, the approach, and the repair performed, including any separately described associated procedure. The day-before preoperative visit and 90 days of related postoperative care are included in the global period. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral adjustment is inappropriate for this anatomy. Assistant-at-surgery payment may be made; 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 57305 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $915.05 |
| Rest Of Oregon | Unavailable | $868.49 |
How the 57305 rate is calculated
Each of 57305’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 · 57305
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 14.97Practice expense 8.98Malpractice 2.97
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 57305
57305 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 57305
Fistula repair
| 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 · 57305
Fistula 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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
57305 without 51 · national facility
$899.15
Fistula repair
57305-51 · Second procedure: 50%
$449.58
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%).
57305 compared with similar codes
Compare codes
57305 vs 57300 vs 57307 vs 57308 vs 57320: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 57300Fistula repair
- Choose 57300 for a vaginal approach; 57305 is for repair through an abdominal approach.
- 57307Fistula repair
- 57307 describes abdominal fistula repair with a colostomy. Use 57305 when the documented service does not include that added procedure.
- 57308Fistula repair
- 57308 is associated with a perineal approach and sphincteroplasty, rather than the abdominal approach represented by 57305.
- 57320Fistula repair
- 57320 concerns a bladder-to-vagina fistula. Code 57305 is for a connection between the rectum and vagina.
57305 billing questions
How do I distinguish this code from 57300?
Use 57305 when the fistula repair is performed through an abdominal approach. Code 57300 describes the vaginal approach.
Does this code include a colostomy?
No. When the abdominal fistula repair is performed with a colostomy, consider 57307 and document the additional procedure.
Should modifier 50 be reported?
No. Bilateral adjustment is inappropriate for this rectum-to-vagina fistula repair.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What postoperative care is included?
The global period includes the day-before preoperative visit and 90 days of related postoperative care.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
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
Fee sheets
Put 57305 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →