Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 56805 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
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.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Female Genital System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | None KX - Requirements specified in the medical policy have been met 51 - Multiple procedures |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 56805 |
| Medicaid Fee Schedule | View Medicaid rates for 56805 |
National average reimbursement for CPT 56805 by major payers:
$1,476.65
$1,558.63
$1,594.43
$1,882.28
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 56805.
CPT 56805
5 of 25 sample ratesHigher to lower in this preview
Ambulatory Surgical Center Of Somerville LLC, Somerset Ambulatory Surgical Center
$3,273.00Published rateVance Thompson Vision Surgery Center Billings, LLC
$2,300.00Published rateCedar Hills Ambulatory Surgery Center LLC, Cedar Hills Surgery Center
Cedar Hills Ambulatory Surgery Center LLC
$1,421.00Published rateSunnyside Surgery Center, LLC
Sunnyside Surgery Center LLC
$1,080.00Published rateCenter For Digestive Health LLC
$743.00Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 56805 vs. Other Surgical Procedures on the Female Genital System Codes
The CPT 56805 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 56805 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 56805. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 56805 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 56805) and we'll show you how you compare in 15 minutes or less.