No office rate
56800 repairs the vaginal opening; 56810 is for nonobstetrical perineoplasty focused on the perineum or perineal body.
On this page
CMS RVU26D · Effective 2026-10-01
56800 Introital repair Medicare reimbursement rates in Virginia
Reports surgical reshaping or reconstruction of the vaginal opening, typically to correct introital narrowing, scarring, or distortion. Compare 56800 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 56800 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
$219.33–$250.26
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 56800: Plastic repair of the vaginal opening
Reports surgical reshaping or reconstruction of the vaginal opening, typically to correct introital narrowing, scarring, or distortion.
CPT 56800 covers surgical reshaping or reconstruction of the vaginal opening. A gynecologic surgeon may perform it when the introitus is narrowed, scarred, or distorted and requires plastic repair. The operative record should identify the affected anatomy, the reason for repair, and the work performed. This is distinct from a repair focused on the perineal body or a procedure directed at labial adhesions or hymenal tissue.
Report the code for the introital repair performed, not simply because the operative site is near the vaginal opening. Related postoperative visits during the 10-day global period are included. When multiple procedures are performed in the same session, Medicare pays the highest-valued procedure in full and reduces the others by 50%. Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; co-surgeons are paid only with supporting documentation, and team surgery is not permitted.
CMS billing rules for 56800
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days 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 RVU3.83 · 56%
- Practice expense (office) RVU2.31 · 34%
- Malpractice RVU0.66 · 10%
149
Medicare services in 2024 · #4567 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.
56800 compared with similar codes
Office rates for Virginia, from the same CMS release.
$177.24–$205.93
56441 releases labial adhesions. Use 56800 when the documented procedure is plastic repair of the introitus, not simply separation of fused labia.
No office rate
56700 is hymenotomy for an obstructing hymen. It is not the code for reconstructive repair of the vaginal opening.
Compare 56800 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
$250.26
Virginia →
Office / nonfacility
Unavailable
Facility
$219.33
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56800 billing questions
When should I report 56800 rather than perineoplasty?
Report 56800 when the operative work plastically repairs the vaginal opening itself. A repair focused on the perineal body may fit 56810 instead.
Is lysis of labial adhesions the same service?
No. Lysis of labial adhesions addresses fused labial tissue; 56800 describes plastic repair of the introitus. Select the code that matches the documented anatomy and work.
Can I append modifier 50 for bilateral work?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
Are related postoperative visits separately payable during the global period?
Related postoperative visits during the 10-day global period are included in the procedure payment.
How are multiple procedures handled in the same session?
Medicare pays the highest-valued procedure in full and reduces the other procedures by 50%.
What documentation supports reporting 56800?
Document the indication, the specific introital anatomy involved, and the plastic repair performed. The record should distinguish this work from a perineal-body repair or lysis of labial adhesions.
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.
6,42056640,,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
6,42456805,,Clitoroplasty intersex state,A,,19.38,7.89,NA,7.89,,3.39,30.66,30.66,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,42556810,,Perineoplasty rpr per nonob,A,,4.18,2.33,NA,2.33,,0.71,7.22,7.22,0,010,0.10,0.80,0.10,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,42656820,,Colposcopy vulva,A,,1.46,2.10,,0.53,,0.27,3.83,2.26,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00