$67.64
Use 57170 for fitting a contraceptive diaphragm or cervical cap. Use 57160 for insertion of a pessary or another vaginal device, typically for pelvic support.
On this page
CMS RVU26D · Effective 2026-10-01
57170 Diaphragm fitting Medicare reimbursement rates in Vermont
Report this service when a clinician selects and assesses the fit of a contraceptive diaphragm or cervical cap for a patient. Compare 57170 office and facility rates across CMS payment localities in Vermont.
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 57170 in Vermont?
Vermont has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$69.80
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
Facility setting
$38.71
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
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.
Gynecology
About 57170: Contraceptive diaphragm or cap fitting
Report this service when a clinician selects and assesses the fit of a contraceptive diaphragm or cervical cap for a patient.
A clinician fits a contraceptive diaphragm or cervical cap by selecting an appropriate device size and assessing how it sits in the vagina. The service is typically performed in an office gynecology or family-planning visit. The fitting is distinct from placing a pessary for pelvic support or inserting an intrauterine device. Documentation should identify the barrier device fitted, the fitting assessment, and any relevant instruction provided to the patient.
Report 57170 for the fitting service, not for a general contraception discussion alone. The record should support that a diaphragm or cap was actually assessed for fit. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. 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 multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 57170
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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 is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU0.89 · 41%
- Practice expense (office) RVU1.13 · 52%
- Malpractice RVU0.16 · 7%
86
Medicare services in 2024 · #4992 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.
57170 compared with similar codes
Office rates for Vermont, from the same CMS release.
58300
No office rateInsert intrauterine device
Code 58300 reports IUD insertion. It is a different contraceptive method, not a diaphragm or cervical-cap fitting.
99401
No office ratePrev med cnsl indiv apprx 15
Code 99401 describes individual preventive counseling. It is not a substitute for 57170 when a diaphragm or cap is actually fitted.
Compare 57170 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.
1 of 1 payment localities
Vermont →
Office / nonfacility
$69.80
Facility
$38.71
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 57170 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
6,449
- Code
- 57170
- Physician work
- 0.89
- Practice expense
- 1.13
- Malpractice
- 0.16
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.89 | × 1.000 | 0.8900 |
| Practice expense | 1.13 | × 0.990 | 1.1187 |
| Malpractice | 0.16 | × 0.506 | 0.0810 |
| Total RVUs | 2.0897 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Vermont$69.80
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.89 | 1 |
| Practice expense | 1.13 | 0.99 |
| Malpractice | 0.16 | 0.506 |
(0.89 × 1 + 1.13 × 0.99 + 0.16 × 0.506) × $33.4009 = $69.80
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.89 | 1 |
| Practice expense | 0.19 | 0.99 |
| Malpractice | 0.16 | 0.506 |
(0.89 × 1 + 0.19 × 0.99 + 0.16 × 0.506) × $33.4009 = $38.71
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
57170 billing questions
How is 57170 different from 57160?
57170 is for fitting a contraceptive diaphragm or cervical cap. Code 57160 concerns insertion of a pessary or another device, commonly for pelvic support.
Does a contraception discussion alone support 57170?
No. The record should show that a diaphragm or cap was fitted and that its fit was assessed; discussion without fitting is not this service.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What happens when another procedure is performed in the same session?
CMS applies the standard multiple-procedure reduction: the highest-valued procedure is paid in full, and other procedures are paid at 50%.
What are the assistant and surgical-team payment rules?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons and team surgery are 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.
6,44657155,,Insert uteri tandem/ovoids,A,,5.02,6.42,,1.66,,0.46,11.90,7.14,0,000,0.00,0.00,0.00,2,0,1,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,44757156,,Ins vag brachytx device,A,,2.62,3.87,,0.97,,0.21,6.70,3.80,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,44857160,,Insert pessary/other device,A,,0.87,1.09,,0.19,,0.15,2.11,1.21,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,44957170,,Fitting of diaphragm/cap,A,,0.89,1.13,,0.19,,0.16,2.18,1.24,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,45057180,,Treat vaginal bleeding,A,,1.59,3.80,,1.34,,0.27,5.66,3.20,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,45157200,,Repair of vagina,A,,4.31,4.01,NA,4.01,,0.80,9.12,9.12,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,45257210,,Repair vagina/perineum,A,,5.57,4.05,NA,4.05,,1.01,10.63,10.63,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817