$177.24–$205.93
Use 56442 for an incision of obstructing hymenal tissue. Use 56441 when the procedure divides labial adhesions.
On this page
CMS RVU26D · Effective 2026-10-01
56442 Hymenotomy Medicare reimbursement rates in Virginia
Hymenotomy opens obstructing hymenal tissue, commonly to relieve menstrual outflow obstruction from an imperforate hymen. Compare 56442 office and facility rates across CMS payment localities in Virginia.
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 56442 in Virginia?
Virginia 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
$42.28–$48.55
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.
Gynecology procedure
About 56442: Hymenal opening procedure
Hymenotomy opens obstructing hymenal tissue, commonly to relieve menstrual outflow obstruction from an imperforate hymen.
A gynecologist performs a hymenotomy by incising hymenal tissue to create an opening, most often when an imperforate hymen obstructs menstrual outflow. Patients may present with cyclic pelvic pain or retained menstrual fluid; the procedure may be performed in an office or outpatient surgical setting, depending on the clinical situation and anesthesia needs.
Report 56442 when the treated obstruction is at the hymen, rather than the labia or vaginal canal. The record should identify the hymenal abnormality, the resulting symptoms or obstruction, and the incision performed. The 0-day global period includes same-day preoperative and postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and the others are subject to the standard 50% 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 56442
- 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 RVU0.66 · 50%
- Practice expense (office) RVU0.53 · 40%
- Malpractice RVU0.12 · 9%
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.
56442 compared with similar codes
Office rates for Virginia, from the same CMS release.
No office rate
Use 56700 when an obstructing vaginal septum is excised; 56442 addresses obstruction at the hymen.
$141.90–$165.37
56405 is for drainage of a vulvar or perineal abscess, not opening hymenal tissue.
$177.51–$208.12
56420 addresses drainage of a Bartholin gland abscess; 56442 is selected for hymenal obstruction.
Compare 56442 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
Dc + Md/Va Suburbs →
Office / nonfacility
Unavailable
Facility
$48.55
Virginia →
Office / nonfacility
Unavailable
Facility
$42.28
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.
56442 billing questions
When should 56442 be selected instead of lysis of labial adhesions?
Use 56442 when the obstructing tissue is the hymen. Use 56441 when labial adhesions are the tissue being divided.
What documentation supports reporting a hymenotomy?
Document the hymenal abnormality, the symptoms or outflow obstruction it causes, and the incision performed to open the hymen.
Is same-day evaluation and follow-up included?
Yes. The 0-day global period includes same-day preoperative and postoperative care.
How does Medicare handle other procedures performed in the same session?
The highest-valued procedure is paid in full; other procedures in the session are subject to the standard multiple-procedure reduction.
Can modifier 50 or an assistant-at-surgery claim be used?
Modifier 50 is inappropriate for this code. Assistant-at-surgery payment is allowed only when medical necessity is documented.
Can co-surgeons or a surgical team report this procedure?
No. CMS does not permit co-surgeons or team surgery for this code.
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.
6,40456420,,I&d bartholins gland abscess,A,,1.40,3.81,,1.36,,0.24,5.45,3.00,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,40556440,,Mrsplzatn brthlns glnd cst,A,,2.82,1.60,NA,1.60,,0.48,4.90,4.90,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,40656441,,Lysis of labial adhesions,A,,1.97,3.15,,1.90,,0.34,5.46,4.21,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,40756442,,Hymenotomy,A,,0.66,0.53,NA,0.53,,0.12,1.31,1.31,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,40856501,,Destroy vulva lesions sim,A,,1.54,3.75,,1.80,,0.25,5.54,3.59,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,40956515,,Destroy vulva lesion/s compl,A,,3.00,4.67,,2.18,,0.51,8.18,5.69,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,41056605,,Biopsy of vulva/perineum,A,,1.07,1.54,,0.29,,0.19,2.80,1.55,0,000,0.00,0.00,0.00,2,0,1,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00