CPT 57109 Fee Schedule
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.
| 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 • 51 - Multiple procedures • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
National average reimbursement for CPT 57109 by major payers:
$2,129.80
$2,255.33
$2,248.18
$2,832.73
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 57109 | ||||||
United | 57109 | $1660.00 | 1891286860 - SANDY SPRINGS CENTER FOR UROLOGIC SURGERY LLC | 825437441 - (GA) SANDY SPRINGS CENTER FOR UROLOGIC SURGERY LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 57109 | $2877.00 | 1073545299 - OREGON OUTPATIENT SURGERY CENTER LLC | 223883387 - (OR) OREGON OUTPATIENT SURGERY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 57109 | $2206.00 | 1093772840 - THE SURGERY CENTER AT JENSEN BEACH, LLC | 651198731 - (FL) THE SURGERY CENTER AT JENSEN B | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 57109 | $2762.00 | 1114196151 - SUMMIT AMBULATORY SURGICAL CENTER LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 57109 | $6136.04 | 1366819799 - PRIME HEALTHCARE SERVICES-SUBURBAN HOSPITAL LLC | 472819044 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 57109 | $2388.00 | 1114034006 - SURGICAL CENTER AT MILLBURN, LLC | 571166137 - (NJ) SURGICAL CENTER AT MILLBURN LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 57109 | $2859.00 | 1366416125 - TEXAS ORTHOPEDICS SURGERY CENTER, LLC, TEXAS ORTHOPEDICS SURGERY CENTER LIMITED PARTNERSHIP, LL | 743013713 - (TX) TEXAS ORTHOPEDICS SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 57109 | $1376.00 | 1437250248 - GEORGIA SURGICAL CENTER ON PEACHTREE, LLC | 582394271 - (GA) GEORGIA SURGICAL CENTER ON PEACHTREE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 57109 | $360.00 | 1497895676 - DEKALB GASTROENTEROLOGY ASSOCIATES III, LLC, DEKALB ENDOSCOPY CENTER | 582316075 - (GA) DEKALB GASTROENTEROLOGY ASSOCIATES III LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 57109 | $1968.00 | 1174185649 - PISA ASC HOLDCO LLC, PAIN INSTITUTE OF SOUTHERN ARIZONA PROCEDURE CENTER | 831944129 - (AZ) PISA ASC HOLDCO LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 57109 | $3099.00 | 1003119470 - MOUNTAIN WEST SURGERY CENTER, LLC | 371614424 | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 57109 | $1291.00 | 1801899687 - TRINITY SURGERY CENTER LLC, BAYCARE SURGERY CENTER | 20656933 - (FL) TRINITY SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 57109 | $814.00 | 1578567954 - E. RONALD SALVITTI, M.D., INC., SOUTHWESTERN PA EYE SURGERY CENTER | 251787703 - (PA) E. RONALD SALVITTI, M.D., INC. | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 57109 | $847.00 | 1578525283 - PRINCETON ENDOSCOPY CENTER LLC | 200445094 - (NJ) PRINCETON ENDOSCOPY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 57109 | $1000.00 | 1063853174 - NATIONAL SURGICAL CENTERS OF AMERICA LLC, NSCOA THE VILLAGES | 264278807 - (FL) NATIONAL SURGICAL CENTERS OF AMERICA LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 57109 vs. Other Surgical Procedures on the Female Genital System Codes
The CPT 57109 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 57109 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 |
|---|---|---|
| 57100-CPT | Low | Biopsy Of Vaginal Mucosa; Simple-Separat |
| 57105-CPT | Moderate | Biopsy Vaginal Musoca Extensive |
| 57106-CPT | Moderate | Vaginectomy Partial Removal Of Vaginal Wall |
| 57109-CPT | High | Vaginectomy, Partial Removal Of Vaginal Wall; With Removal Of Paravaginal Tissue (Radical Vaginectomy) With Bilateral Total Pelvic Lymphadenectomy And Para-Aortic Lymph Node Sampling (Biopsy) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 57109. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 57109 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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