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See a sample rate comparisonCPT 56405 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Drain Genital Cyst Or Abscess, Procedure To Drain An Abscess Or Cyst (Pocket Of Infection Or Fluid) On The External Genitals Or The Bartholins Gland (Either Side Of The Vagina). The Procedure May Involve Creating A Skin Pocket To Prevent Future Cysts Around The Gland.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Female Genital System |
| Common Place of Service | 11 - Office 23 - Emergency Room |
| Common Modifiers | None AG - Primary physician UA |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 56405 |
| Medicaid Fee Schedule | View Medicaid rates for 56405 |
National average reimbursement for CPT 56405 by major payers:
$171.98
$161.80
$184.60
$215.48
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CPT 56405
5 of 25 sample ratesHigher to lower in this preview
Childrens National Medical Center
Childrens Hospital
$3,783.00Published rateWayne Farley
Billings Clinic
$317.33Published rateAmy Gessford
Deaconess Hospital Inc
$200.33Published ratePaul Megehee
$129.50Published rateDiane Hartmann
University Of Rochester
$14.15Published rate
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See a sample payer proposalCPT 56405 vs. Other Surgical Procedures on the Female Genital System Codes
The CPT 56405 code is part of the Surgery services used for Surgical Procedures on the Female Genital System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 56405 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 56405-CPT | Low | Drain Genital Cyst Or Abscess, Procedure To Drain An Abscess Or Cyst (Pocket Of Infection Or Fluid) On The External Genitals Or The Bartholins Gland (Either Side Of The Vagina). The Procedure May Involve Creating A Skin Pocket To Prevent Future Cysts Around The Gland. |
| 56420-CPT | Moderate | Drain Genital Cyst Or Abscess, Procedure To Drain An Abscess Or Cyst (Pocket Of Infection Or Fluid) On The External Genitals Or The Bartholins Gland (Either Side Of The Vagina). The Procedure May Involve Creating A Skin Pocket To Prevent Future Cysts Around The Gland. |
| 56440-CPT | Moderate | Drain Genital Cyst Or Abscess, Procedure To Drain An Abscess Or Cyst (Pocket Of Infection Or Fluid) On The External Genitals Or The Bartholins Gland (Either Side Of The Vagina). The Procedure May Involve Creating A Skin Pocket To Prevent Future Cysts Around The Gland. |
| 56441-CPT | Moderate | Removal Of Genital Scar Tissue, Surgical Release Of Scar Tissue That Has Fused Together The Two Folds Of Skin (Labia) On Either Side Of The Vaginal Opening. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 56405. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 56405 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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