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See a sample rate comparisonCPT 56800 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.
Plastic Repair Of Introitus
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Female Genital System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | None 51 - Multiple procedures 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 56800 |
| Medicaid Fee Schedule | View Medicaid rates for 56800 |
National average reimbursement for CPT 56800 by major payers:
$301.03
$330.87
$336.68
$408.00
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CPT 56800
5 of 25 sample ratesHigher to lower in this preview
The Endoscopy Center At St. Francis, LLC
The Endoscopy Center At St Francis LLC
$7,842.00Published rateAmarillo Endoscopy Center, Lp
Amarillo Endoscopy Center Lp
$2,206.00Published rateOrthoatlanta Surgery Center Of Fayetteville, LLC
Orthoatlanta Surgery Center Of Fayetteville LLC
$1,376.00Published rateMayfair Digestive Health Center, LLC
Mayfair Digestive Health Center LLC
$944.88Published rateTifton Endoscopy Center, Inc.
$544.00Published rate
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See a sample payer proposalCPT 56800 vs. Other Surgical Procedures on the Female Genital System Codes
The CPT 56800 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 56800 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 |
|---|---|---|
| 56700-CPT | Moderate | Surgery On The Hymen, Surgery To Remove All Or Part Of The Membrane Covering The Vaginal Opening (Hymen). This Opens The Vagina For Normal Post-Puberty Functions Such As Menstruation Childbirth And Sex. |
| 56740-CPT | Moderate | Remove Genital Gland Or Cyst, Surgery To Remove One Or Both Bartholins Glands Which Are Located On Either Side Of The Vagina. The Procedure May Instead Remove A Cyst (Pocket Of Fluid) From The Gland. |
| 56800-CPT | Moderate | Plastic Repair Of Introitus |
| 56805-CPT | High | Surgery To Reshape Clitoris, Surgery To Alter A Clitoris That Is Larger Or Smaller Than Normal. The Procedure Is Done To Correct Improper Sexual Development In A Newborn. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 56800. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 56800 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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