Summary & Overview
CPT 56700: Hymenotomy and Hymenal Ring Revision
CPT code 56700 denotes a minor gynecologic surgical procedure involving partial removal of the hymenal membrane or revision of the hymenal ring. The code is used to report targeted anatomic hymenal procedures and is relevant across ambulatory surgical centers, hospital outpatient departments, and, where permitted, office-based surgical settings. Nationally, clear coding for hymenal revision supports accurate procedure capture for clinical records, coverage determination, and claims adjudication.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for the procedure, common sites of service, and typical billing considerations. The publication outlines benchmark elements such as typical settings and payer recognition, highlights policy and coverage themes affecting payment and prior authorization, and summarizes areas where credentialing or site-of-service rules commonly influence claim processing.
This summary is intended for clinicians, billing professionals, and policy analysts seeking clarity on the clinical intent and typical administrative handling of CPT code 56700. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 56700 describes a surgical procedure in which the provider partially removes the hymenal membrane or revises the hymenal ring. This procedure is a minor gynecologic surgical service focused on anatomic revision of the hymen.
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Service type: Minor gynecologic surgical procedure
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Typical site of service: Ambulatory surgery center or hospital outpatient department; may also be performed in an office setting when appropriate and allowed by payer policy
Data not available in the input for associated taxonomies and ICD-10 diagnoses.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adolescent or adult female presenting to a gynecology clinic or outpatient surgical center with symptomatic imperforate, microperforate, or rigid hymenal tissue causing pain, difficulty with tampon use, dyspareunia, or obstructive menstrual flow. The clinical workflow includes history and focused pelvic exam, discussion of goals and consent (including fertility and sexual function implications), preoperative counseling about anesthesia options (local, monitored anesthesia care, or general), marking of surgical site, sterile prep, and procedure performed in an outpatient procedure room or ambulatory surgery center. After partial hymen removal or hymenal ring revision, hemostasis is achieved, verbal and written postoperative instructions are provided, follow-up arranged within 1–4 weeks, and analgesics and wound care guidance prescribed as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal or routine service | When the procedure represents the physician's typical service for the encounter |
22 | Increased procedural services | For unusually extensive dissection or prolonged operative time beyond typical scope |