No office rate
Both address revision or removal of a prosthetic vaginal graft. Choose based on whether the surgeon uses a vaginal or abdominal approach.
On this page
CMS RVU26D · Effective 2026-10-01
57295 Vaginal graft revision Medicare reimbursement rates in Pennsylvania
Reports vaginally performed revision or removal of a previously placed prosthetic vaginal graft, such as for graft exposure, scarring, or related symptoms. Compare 57295 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 57295 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
$433.78–$467.41
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.
Gynecologic surgery
About 57295: Vaginal graft revision through vaginal approach
Reports vaginally performed revision or removal of a previously placed prosthetic vaginal graft, such as for graft exposure, scarring, or related symptoms.
A surgeon, commonly a urogynecologist or gynecologist, accesses a previously placed prosthetic graft through the vagina and revises or removes it. The service may address problems such as graft exposure, contraction, or pain after pelvic floor surgery. It is not the initial placement of a graft, and the approach is vaginal rather than abdominal.
Select this code when the operative report documents work on an existing vaginal graft and describes the vaginal route. Record the reason for revision, the graft involved, and the work performed, including whether graft material was removed. This major surgery has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. 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 50% multiple-procedure reduction. Modifier 50 is not appropriate. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team-surgery payment is not permitted.
CMS billing rules for 57295
- 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 RVU7.62 · 57%
- Practice expense (office) RVU4.57 · 34%
- Malpractice RVU1.24 · 9%
951
Medicare services in 2024 · #3009 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.
57295 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
No office rate
Use 57287 for revision or removal of a urethral sling. This code concerns a prosthetic vaginal graft used for pelvic support.
No office rate
Use 57285 for vaginal repair of a paravaginal defect. This code requires revision or removal of a previously placed vaginal graft.
Compare 57295 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
$467.41
Rest Of Pennsylvania →
Office / nonfacility
Unavailable
Facility
$433.78
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57295 billing questions
How is this different from 57296?
This code is for revising or removing a prosthetic vaginal graft through the vagina. Code 57296 describes the abdominal approach.
Can this be reported for the original graft placement?
No. Report it for revision or removal of a previously placed graft, not for initial graft placement.
What documentation supports reporting this code?
Document the existing graft, the clinical reason for the procedure, the vaginal approach, and the revision or removal performed.
Should modifier 50 be appended for grafts on both sides?
No. Modifier 50 is not appropriate for this service.
How does the global period affect postoperative visits?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team-surgery payment 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.
6,46957289,,Repair bladder & vagina,A,,12.48,6.28,NA,6.28,,2.19,20.95,20.95,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,47057291,,Construction of vagina,A,,8.42,4.73,NA,4.73,,1.47,14.62,14.62,0,090,0.12,0.74,0.14,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,47157292,,Construct vagina with graft,A,,13.66,5.85,NA,5.85,,2.39,21.90,21.90,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,47257295,,Revise vag graft via vagina,A,,7.62,4.57,NA,4.57,,1.24,13.43,13.43,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,47357296,,Revise vag graft open abd,A,,16.15,6.26,NA,6.26,,2.83,25.24,25.24,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,47457300,,Repair rectum-vagina fistula,A,,8.49,6.79,NA,6.79,,1.61,16.89,16.89,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,47557305,,Repair rectum-vagina fistula,A,,14.97,8.98,NA,8.98,,2.97,26.92,26.92,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00