No office rate
Both include complete radical vulvectomy and bilateral inguinofemoral lymphadenectomy. Choose 56640 when pelvic lymph node dissection is also performed as part of the operation.
On this page
CMS RVU26D · Effective 2026-10-01
56640 Radical vulvectomy Medicare reimbursement rates in Texas
Reports complete radical removal of the vulva with bilateral inguinofemoral and pelvic lymph node dissection, typically for invasive vulvar malignancy. Compare 56640 office and facility rates across CMS payment localities in Texas.
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 56640 in Texas?
Texas has 8 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 8 payment areas shown below, using the same CMS release.
Office / nonfacility
No 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.
Where 56640 pays more and less in Texas
Gynecologic surgery
About 56640: Complete radical vulvectomy with pelvic node dissection
Reports complete radical removal of the vulva with bilateral inguinofemoral and pelvic lymph node dissection, typically for invasive vulvar malignancy.
This operation removes the vulva in its entirety as a radical cancer procedure and includes bilateral inguinofemoral lymphadenectomy and pelvic lymph node dissection. It is generally performed by a gynecologic oncologist in a hospital or other surgical facility for selected patients with invasive vulvar cancer when the operative plan includes this extent of nodal surgery. The groin and pelvic node work is part of the service represented by this code.
Select this code when the operative report supports complete radical vulvar removal and both the bilateral inguinofemoral and pelvic node dissections; a partial resection or a procedure without pelvic node dissection points to a different code in the family. 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 one session, the highest-valued procedure is paid in full and the others at 50%. A qualifying bilateral service reported with modifier 50 is paid at 150%. Assistant-at-surgery payment may be allowed; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 56640
- 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 procedure with modifier 50 is paid at 150%.
- 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 RVU24.16 · 56%
- Practice expense (office) RVU13.13 · 31%
- Malpractice RVU5.59 · 13%
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.
56640 compared with similar codes
Office rates for Texas, from the same CMS release.
No office rate
56634 covers complete radical vulvectomy with unilateral inguinofemoral lymphadenectomy. It does not represent the bilateral groin and pelvic node dissection included in 56640.
No office rate
56633 represents complete radical vulvectomy without the lymphadenectomy components. Use 56640 when the documented operation also includes bilateral inguinofemoral and pelvic node dissection.
Compare 56640 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.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Office Unavailable | Facility $1438.00 |
| Beaumont | Office Unavailable | Facility $1379.50 |
| Brazoria | Office Unavailable | Facility $1393.66 |
| Dallas | Office Unavailable | Facility $1411.23 |
| Fort Worth | Office Unavailable | Facility $1409.27 |
| Galveston | Office Unavailable | Facility $1403.50 |
| Houston | Office Unavailable | Facility $1505.82 |
| Rest Of Texas | Office Unavailable | Facility $1391.75 |
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.
56640 billing questions
How does 56640 differ from 56637?
56640 includes pelvic lymph node dissection in addition to complete radical vulvectomy and bilateral inguinofemoral lymphadenectomy. Use 56637 when the operative service includes the bilateral groin node dissection but not pelvic node dissection.
Are the groin and pelvic node dissections separately reported?
They are included in 56640 when performed as part of the coded operation. The operative report should document the extent and laterality of the node dissections.
When should 56633 be used instead?
56633 describes complete radical vulvectomy without the inguinofemoral lymphadenectomy included in 56640. The documented operation, rather than the cancer diagnosis alone, determines the appropriate code.
What documentation supports 56640?
Document that the vulvar removal was complete and radical, and describe bilateral inguinofemoral and pelvic lymph node dissection. Include the operative findings and the extent of each surgical component.
How does Medicare handle other procedures performed in the same session?
Under the listed multiple-procedure rule, Medicare pays the highest-valued procedure in full and other procedures at 50%. Related postoperative care for 56640 falls within its 90-day global period.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be allowed. Co-surgeon payment requires supporting documentation, while 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.
6,41756633,,Vulvectomy radical complete,A,,19.13,11.13,NA,11.13,,4.19,34.45,34.45,0,090,0.12,0.74,0.14,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,41856634,,Vlvctmy rad comp uni lymphad,A,,20.14,11.99,NA,11.99,,4.66,36.79,36.79,0,090,0.12,0.74,0.14,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,41956637,,Vlvctmy rad comp bi lymphad,A,,24.13,13.16,NA,13.16,,5.59,42.88,42.88,0,090,0.12,0.74,0.14,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,42056640,,Vlvctmy rad comp w/lymphadec,A,,24.16,13.13,NA,13.13,,5.59,42.88,42.88,0,090,0.12,0.74,0.14,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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