Billing code 57308: Fistula repairMedicare rate & RVUs in Virginia
Reports surgical closure of a rectovaginal fistula through the perineum, when the operative approach is transperineal.
CMS doesn’t publish an office rate for 57308 in Virginia.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 57308 covers
This operation closes an abnormal tract between the rectum and vagina using access through the perineum. It may be performed by a gynecologic surgeon, urogynecologist, or colorectal surgeon in an operating room, including for fistulas related to obstetric injury or prior pelvic surgery. The operative approach, rather than the fistula’s cause, distinguishes this code from other rectovaginal fistula repairs.
Report one unit for the transperineal repair and document the fistula’s anatomy and the route used to reach and close it. The 90-day global period includes the day-before preoperative visit and related postoperative care during the following 90 days. When multiple procedures are performed in the same session, Medicare pays the highest-valued procedure in full and reduces the others to 50%. Modifier 50 is inappropriate; report the repair as a single procedure. Assistant-at-surgery payment may be available, and co-surgeon payment requires supporting documentation. Team surgery is not permitted.
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.
Where 57308 pays more and less in Virginia
| Payment locality | Office | Facility |
|---|---|---|
| Dc + Md/Va Suburbs | Unavailable | $696.86 |
| Virginia | Unavailable | $612.06 |
How the 57308 rate is calculated
Each of 57308’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 57308
RVUs × geographic indexes × conversion factor
Work10.33
10.33 RVUs× 1.000 GPCI
Practice expense7.07
7.07 RVUs× 1.000 GPCI
Malpractice1.48
1.48 RVUs× 1.000 GPCI
Adjusted RVUs
18.8800
Conversion factor
$33.4009
Medicare rate
$630.61
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 57308
57308 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 57308
Fistula repair
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.12/0.74/0.14 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 57308
Fistula repair
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
57308 without 51 · national facility
$630.61
Fistula repair
57308-51 · Second procedure: 50%
$315.31
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
57308 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 57300Fistula repair
- Choose 57300 for rectovaginal fistula closure through a vaginal or transanal route; choose 57308 when the surgeon uses a transperineal route.
- 57305Fistula repair
- 57305 uses an abdominal approach for rectovaginal fistula closure. The approach for 57308 is transperineal.
- 57307Fistula repair
- 57307 describes abdominal rectovaginal fistula repair with colostomy. Code 57308 identifies transperineal closure.
- 57310Fistula repair
- 57310 concerns a urethrovaginal fistula, not a tract between the rectum and vagina.
57308 billing questions
How does 57308 differ from 57300?
Both address rectovaginal fistula closure, but 57308 uses a transperineal route. Code 57300 is selected for a vaginal or transanal approach.
When is 57305 or 57307 the better choice?
Those codes describe an abdominal approach to rectovaginal fistula closure. Code 57307 also identifies repair with colostomy; 57308 is for the transperineal approach.
What documentation supports reporting 57308?
The operative report should identify the rectovaginal fistula and describe the transperineal route used for its closure.
Can modifier 50 be reported?
No. Modifier 50 is inappropriate for this single-anatomy repair; report the transperineal procedure without it.
How does the global period affect postoperative billing?
The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days after surgery.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation, and 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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
Fee sheets
Put 57308 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →