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See a sample rate comparisonCPT 56442 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.
Procedure To Open The Hymen, The Procedure Surgically Cuts Through The Membrane Covering The Vaginal Opening (Hymen). This Opens The Vagina For Normal Post-Puberty Functions Such As Menstruation Childbirth And Sex.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Female Genital System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 11 - Office |
| Common Modifiers | None 51 - Multiple procedures 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 56442 |
| Medicaid Fee Schedule | View Medicaid rates for 56442 |
National average reimbursement for CPT 56442 by major payers:
$62.12
$63.65
$64.61
$88.87
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CPT 56442
5 of 25 sample ratesHigher to lower in this preview
Beltway Surgery Centers, L.L.C.
$8,705.00Published rateHuebner Creek Surgery Center, PLLC
Huebner Ambulatory Surgery Center LLC
$2,250.00Published ratePalm Beach Regional Opco LLC
$1,611.00Published rateNorthwest Renal Clinic, Inc., Northwest Dialysis Access Center
Northwest Renal Clinic, PC
$1,260.00Published rateDelmarva Endoscopy Center LLC
$800.00Published rate
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See a sample payer proposalCPT 56442 vs. Other Surgical Procedures on the Female Genital System Codes
The CPT 56442 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 56442 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. |
| 56442-CPT | Low | Procedure To Open The Hymen, The Procedure Surgically Cuts Through The Membrane Covering The Vaginal Opening (Hymen). This Opens The Vagina For Normal Post-Puberty Functions Such As Menstruation Childbirth And Sex. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 56442. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 56442 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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