No office rate
Both represent combined anterior and posterior vaginal wall repair. Choose 57265 when the operation also repairs an enterocele; choose 57260 when it does not.
On this page
CMS RVU26D · Effective 2026-10-01
57265 Vaginal prolapse repair Medicare reimbursement rates in Pennsylvania
Reports vaginal repair of both anterior and posterior wall prolapse with repair of an enterocele during the same operation. Compare 57265 office and facility rates across CMS payment localities in Pennsylvania.
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 57265 in Pennsylvania?
Pennsylvania 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
$747.53–$801.07
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.
Urogynecologic surgery
About 57265: Combined vaginal wall and enterocele repair
Reports vaginal repair of both anterior and posterior wall prolapse with repair of an enterocele during the same operation.
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.
CMS billing rules for 57265
- 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 RVU14.63 · 64%
- Practice expense (office) RVU5.89 · 26%
- Malpractice RVU2.48 · 11%
5.3K
Medicare services in 2024 · #1838 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.
57265 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
No office rate
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.
No office rate
57240 represents anterior vaginal wall repair alone. It is not the combined anterior and posterior repair with enterocele repair represented by 57265.
No office rate
57250 represents posterior vaginal wall repair alone. Use 57265 when the operation repairs both vaginal compartments and an enterocele.
Compare 57265 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 Philadelphia →
Office / nonfacility
Unavailable
Facility
$801.07
Rest Of Pennsylvania →
Office / nonfacility
Unavailable
Facility
$747.53
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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 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.
6,45557240,,Anterior colporrhaphy,A,,9.83,4.88,NA,4.88,,1.61,16.32,16.32,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,45657250,,Repair rectum & vagina,A,,9.83,4.85,NA,4.85,,1.65,16.33,16.33,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,45757260,,Cmbn ant pst colprhy,A,,12.92,5.49,NA,5.49,,2.17,20.58,20.58,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,45857265,,Cmbn ap colprhy w/ntrcl rpr,A,,14.63,5.89,NA,5.89,,2.48,23.00,23.00,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,45957267,,Insert mesh/pelvic flr addon,A,,4.76,1.02,NA,1.02,,0.78,6.56,6.56,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,46057268,,Repair of bowel bulge,A,,7.38,5.02,NA,5.02,,1.27,13.67,13.67,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,46157270,,Repair of bowel pouch,A,,13.33,5.95,NA,5.95,,2.30,21.58,21.58,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00