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See a sample rate comparisonCPT 57296 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.
Rvision (Inclu Remval) Of Prosthet Vagnal Grft; Open Abdomi, Revision (Including Removal) Of Prosthetic Vaginal Graft; Open Abdomin
| 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 AS - PA/NP/CNS assistant at surgery 22 - Increased Procedural Services 80 - Assistant surgeon |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 57296 |
| Medicaid Fee Schedule | View Medicaid rates for 57296 |
National average reimbursement for CPT 57296 by major payers:
$1,193.22
$1,265.20
$1,258.64
$1,554.55
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CPT 57296
5 of 25 sample ratesHigher to lower in this preview
Houston Urologic Surgicenter, LLC
$2,785.00Published rateFlorham Park Endoscopy Asc LLC, Florham Park Endoscopy Center
Florham Park Endoscopy Center, LLC
$1,042.00Published rateCharleston Surgery Center Limited Partnership
$850.00Published rateChadds Ford Ambulatory Surgical Center, LLC
Chadds Ford Ambulatory Surgical Center LLC
$500.00Published rateGastroenterology Specialists Inc, Endoscopy Center
Gastroenterology Specialists, Inc.
$106.00Published rate
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See a sample payer proposalCPT 57296 vs. Other Surgical Procedures on the Female Genital System Codes
The CPT 57296 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 57296 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 |
|---|---|---|
| 57291-CPT | Moderate | Construct Artificial Vagina Wo Grft |
| 57295-CPT | Moderate | Rvision (Inclu Remval) Of Prosthet Vagnal Grft; Vagnal Appr, Revision (Including Removal) Of Prosthetic Vaginal Graft; Vaginal Appr |
| 57296-CPT | High | Rvision (Inclu Remval) Of Prosthet Vagnal Grft; Open Abdomi, Revision (Including Removal) Of Prosthetic Vaginal Graft; Open Abdomin |
| 57305-CPT | High | Genital Repair Surgery, Surgery To Close An Abnormal Opening Between The Vagina And Rectum. The Procedure May Include A Temporary Bypass For The Rectum (Colostomy) Or Reconstruction Of The Perineum. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 57296. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 57296 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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