No office rate
Both codes address a vesicovaginal fistula. Choose based on the operative route: vaginal for 57320 and abdominal for 57330.
On this page
CMS RVU26D · Effective 2026-10-01
57320 Fistula repair Medicare reimbursement rates in Pennsylvania
Reports surgical closure through the vagina of an abnormal connection between the bladder and vagina, commonly causing continuous urinary leakage. Compare 57320 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 57320 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
$485.62–$523.21
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 57320: Vaginal repair of vesicovaginal fistula
Reports surgical closure through the vagina of an abnormal connection between the bladder and vagina, commonly causing continuous urinary leakage.
This service closes a vesicovaginal fistula, an abnormal passage that allows urine to move from the bladder into the vagina. A gynecologic surgeon or urologist typically performs the repair in an operating room, using vaginal access to expose and close the fistula. These repairs may be needed after pelvic surgery or other injury to the tissues; patients often present with persistent urinary leakage through the vagina.
Select this code when the operative report supports a bladder-to-vagina fistula and a vaginal route of repair. Document the fistula’s location, the approach, and the operative work performed. Medicare 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 the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Report the repair once rather than as a bilateral service. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 57320
- 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 RVU8.66 · 58%
- Practice expense (office) RVU4.86 · 32%
- Malpractice RVU1.50 · 10%
73
Medicare services in 2024 · #5122 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.
57320 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
No office rate
Use 57310 when the fistula connects the urethra and vagina; 57320 is for a connection between the bladder and vagina.
No office rate
This code concerns urethrovaginal fistula repair by an abdominal approach. For bladder-to-vagina repair, distinguish the route and use 57320 for vaginal access or 57330 for abdominal access.
Compare 57320 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
$523.21
Rest Of Pennsylvania →
Office / nonfacility
Unavailable
Facility
$485.62
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
57320 billing questions
When should 57320 be chosen instead of 57330?
Use 57320 for a vesicovaginal fistula repaired through the vagina. Code 57330 describes repair of the same type of fistula through an abdominal approach.
How does 57320 differ from urethrovaginal fistula repair?
The involved structures determine the code: 57320 is for a connection between bladder and vagina, while 57310 and 57311 concern a connection between urethra and vagina.
Is modifier 50 appropriate for this repair?
No. Report the repair once for the fistula; the anatomy does not support bilateral reporting with modifier 50.
What postoperative care is included?
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?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation, and team surgery is not permitted for this service.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures performed in that session 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 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.
6,47757308,,Fistula repair transperine,A,,10.33,7.07,NA,7.07,,1.48,18.88,18.88,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,47857310,,Repair urethrovaginal lesion,A,,7.46,5.02,NA,5.02,,0.96,13.44,13.44,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,47957311,,Repair urethrovaginal lesion,A,,8.69,5.28,NA,5.28,,1.12,15.09,15.09,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,48057320,,Repair bladder-vagina lesion,A,,8.66,4.86,NA,4.86,,1.50,15.02,15.02,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,48157330,,Repair bladder-vagina lesion,A,,12.88,6.09,NA,6.09,,1.65,20.62,20.62,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,48257335,,Repair vagina,A,,19.52,8.07,NA,8.07,,3.43,31.02,31.02,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,48357400,,Dilation of vagina,A,,2.21,0.86,NA,0.86,,0.39,3.46,3.46,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00