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    v1.0.28
    OpenPayerBilling CodesExcision Procedures on the Vulva, Perineum and IntroitusCPT cpt-56640-radical-vulvectomy-with-lymphadenectomy
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    CPT 56640: Radical Vulvectomy with Lymph Node Dissection

    Medicare pays $1448 on average nationally for this procedure.

    CPT code 56640 describes a radical vulvectomy procedure for malignant disease involving removal of the vulva and regional lymphadenectomy (inguinofemoral, iliac, and pelvic nodes), representing a major surgical oncologic service typically performed in an inpatient hospital or surgical center setting under general anesthesia.

    For related coverage guidance, see recent payer policy updates: Prolonged Services for Labor Management, Prolonged Services for Labor Management, Cervical Cancer Screening.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 64-year-old female presents with a biopsy-proven invasive squamous cell carcinoma of the vulva with palpable ipsilateral inguinal lymphadenopathy and imaging suggesting pelvic nodal involvement. After multidisciplinary tumor board review, the plan is a 56640 radical vulvectomy with bilateral inguinofemoral and pelvic lymphadenectomy under general anesthesia. Preoperative workflow includes informed consent, medical clearance, anesthesia evaluation, and staging imaging. Intraoperative steps include wide excision of vulvar tissue including tumor and margin, possible clitoral resection depending on tumor extent, and selective removal of inguinofemoral, iliac, and pelvic lymph nodes. Postoperative workflow includes monitoring in PACU, pain control, wound and drain management, early ambulation, pathology review of margins and nodes, coordination with medical oncology and radiation oncology for adjuvant therapy if indicated, and wound-care follow-up in clinic.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    38571Biopsy or excision of lymph node(s); open; superficial lymph node(s)May be performed if separate diagnostic excision of suspicious nodes is done prior to or during staging.

    | 19318 | Breast reconstruction, immediate or delayed; reduction or modification (flap procedures) | Not typical; included when complex vulvar soft-tissue reconstruction requires myocutaneous or fasciocutaneous flaps (reconstructive procedures performed concurrent with oncologic resection).

    | 99505 | Data not available in the input. | Data not available in the input.

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    P1Modifier P1 indicates an ASA Physical Status I — a normal healthy patient — and is appended to anesthesia CPT codes (00100–01999) based on the anesthesiologist’s clinical assessment. It documents the…- When to apply: Use modifier P1 on anesthesia CPT codes (00100–01999) when the anesthesia provider assigns ASA Physical Status I — a normal healthy patient (non‑smoker, minimal or no alcohol use).…
    99Modifier 99 is a placeholder modifier used when more modifiers apply to a single procedure than the claim form or electronic field allows. The AMA classifies it under Provider Services and Ambulatory…- Use CPT modifier -99 when more modifiers apply to a single procedure line than the claim form or payer field allows (CMS/Noridian: when more than four modifiers are needed); append modifier 99 on…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    376G00000XNursing Home AdministratorAn individual, often licensed by the state, who is responsible for the management of a nursing home.
    2251N0400XNeurology Physical TherapistA licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Neurologic Physical Therapy, who has …
    261QM0850XAdult Mental Health Clinic/CenterAn entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disord…
    261QV0200XVA Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center
    261QC0050XCritical Access Hospital Clinic/CenterAn outpatient entity, facility, or distinct part of a facility within or affiliated with a Critical Access Hospital that provides access to primary ca…
    311Z00000XCustodial Care FacilityA facility providing care that serves to assist an individual in the activities of daily living, such as assistance in walking, getting in and out of …
    163WG0000XGeneral Practice Registered NurseNursing Service Providers · Registered Nurse
    170300000XGenetic Counselor (M.S.)A masters trained health care provider who collects and interprets genetic family histories; assesses the risk of disease occurrence or recurrence; id…

    Related ICD-10-CM Codes

    25 rows

    ICD-10-CM CodeDescription
    C49.4Malignant neoplasm of connective and soft tissue of abdomen
    C51.0Malignant neoplasm of labium majus
    C51.1Malignant neoplasm of labium minus
    C51.2Malignant neoplasm of clitoris
    C51.8Malignant neoplasm of overlapping sites of vulva
    C51.9Malignant neoplasm of vulva, unspecified
    C52Malignant neoplasm of vagina
    C57.8Malignant neoplasm of overlapping sites of female genital organs
    C60.0Malignant neoplasm of prepuce
    C60.1Malignant neoplasm of glans penis

    Showing 1–10 of 25

    Related Payer Policy Updates

    Specialty: Obstetrics/Gynecology1 / 2

    8 rows

    PolicyPayerEffective Date
    Prolonged Services for Labor ManagementPremera Bluecross2027-01-01
    Prolonged Services for Labor ManagementPremera Bluecross2027-01-01
    Cervical Cancer ScreeningOscar Health2026-10-01
    Prenatal Testing for Fetal AneuploidyOscar Health2026-10-01
    Diagnosis of VaginitisOscar Health2026-10-01
    Prenatal Screening (Nongenetic)Oscar Health2026-10-01
    View PDF of Maternal Serum Biomarkers for Prediction of Adverse Obstetric Outcomes, Effective 10/1/2026 in MedicalBlue Cross Blue Shield - Rhode Island2026-10-01
    Maternal Serum Testing for Prediction of Adverse Obstetric OutcomesBluecross Idaho2026-09-01

    Related Codes

    CPT-56605-VULVAR-PERINEAL-LESION-EXCISION-BIOPSY

    CPT 56605: Excision of Single Vulvar or Perineal Lesion

    CPT-56606-EXCISION-VULVA-PERINEUM-ADDITIONAL-LESIONS

    CPT 56606: Excision of Additional Vulvar or Perineal Lesions

    CPT-56620-SIMPLE-VULVECTOMY-GYNECOLOGIC-EXCISION

    CPT 56620: Simple Vulvectomy for Benign or Premalignant Vulvar Conditions

    CPT-56625-SIMPLE-VULVECTOMY-GYNECOLOGIC-SURGERY

    CPT 56625: Simple Vulvectomy for Benign or Premalignant Vulvar Disease

    CPT-56630-RADICAL-VULVECTOMY-MAJOR-ONCOLOGIC-SURGERY

    CPT 56630: Radical Vulvectomy for Malignant Disease

    CPT-56631-RADICAL-VULVECTOMY-UNILATERAL-INGUINOFEMORAL-NODE

    CPT 56631: Radical Vulvectomy with Unilateral Inguinofemoral Lymph Node Dissection

    CPT-56632-RADICAL-VULVECTOMY-WITH-INGUINOFEMORAL-LYMPH-NODE-DISSECTION

    CPT 56632: Radical Vulvectomy with Bilateral Inguinofemoral Lymphadenectomy

    CPT-56633-RADICAL-VULVECTOMY-SURGICAL-ONCOLOGY

    CPT 56633: Radical Vulvectomy for Malignant Disease

    CPT-56634-RADICAL-VULVECTOMY-INGUINOFEMORAL-LYMPH-NODE

    CPT 56634: Radical Vulvectomy with Unilateral Inguinofemoral Lymph Node Removal

    CPT-56637-RADICAL-VULVECTOMY-WITH-BILATERAL-LYMPHADENECTOMY

    CPT 56637: Radical Vulvectomy with Inguinofemoral Lymphadenectomy

    Showing 1–10 of 12

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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