CPT Code 56620 Excision Procedures on the Vulva, Perineum, and Introitus

Accurate CPT coding is essential for OB-GYN providers to ensure compliance, avoid denials, and receive correct reimbursement. CPT 56620 is used to report a partial/simple vulvectomy, which is a therapeutic surgical procedure involving the removal of a portion of vulvar tissue. Since this procedure is more extensive than a biopsy but less extensive than a complete vulvectomy, clear documentation and accurate billing practices are crucial.

This guide, aligned with AAPC and CMS 2025 updates, explains the code definition, clinical indications, modifiers, billing rules, documentation requirements, and reimbursement details, so providers can confidently code and bill for this procedure.

CPT Code 56620 – Description

Official Definition: “Vulvectomy, simple; partial.”

This code represents a surgical procedure where the physician removes part of the vulva to treat precancerous or cancerous conditions, or in cases where less invasive approaches are not sufficient.

Key Points

• This is not a diagnostic biopsy (biopsy is 56605/56606).
• This code is used when a therapeutic removal of vulvar tissue is performed.
• Applies when less than the entire vulva is removed.
• If the excision involves the entire vulva, CPT 56625 (total simple vulvectomy) should be used instead.

When to Use CPT 56620

CPT 56620 should be reported when the physician performs a partial vulvectomy for medical necessity.

Typical Indications Include:

• Vulvar intraepithelial neoplasia (VIN) requiring surgical removal.
• Early-stage vulvar cancer, where a complete vulvectomy is not needed.
• Recurrent or resistant vulvar lesions not responding to conservative treatments.
• Suspicious lesions that require therapeutic removal with margins.

Do not report 56620 when:

• Only a small lesion is excised (use lesion excision codes instead).
• The procedure performed is solely a diagnostic biopsy.
• A total vulvectomy is performed (use 56625 instead).

Coding Guidelines

• Single procedure code: Report 56620 once per surgical session for a partial vulvectomy.
• Bundling rules: Do not bill with biopsy codes for the same lesion. If biopsy and excision are done together on the same tissue, only the vulvectomy is reported.
• Global surgical package: CPT 56620 includes a 90-day global period; postoperative care is bundled.
• Site of service: Typically performed in a hospital or ambulatory surgical center, not an office setting.
• Prior authorization: Some payers require pre-approval for vulvectomy codes due to surgical complexity.

Reimbursement Information

According to the 2025 Medicare Physician Fee Schedule and ASC payment data:

• Average patient cost (ASC): ~$448 (Medicare estimate; regional variation applies).
• Global period: 90 days.
• Multiple surgery reduction: Applies when billed with other major procedures.

Commercial payer reimbursement varies; always check payer-specific fee schedules and coverage policies.

Applicable Modifiers

Use modifiers where appropriate to clarify services and responsibilities:

• Modifier 54 – Surgical care only.
• Modifier 55 – Postoperative management only.
• Modifier 59 – Distinct procedural service (if another unrelated procedure performed same session).
• Modifier 51 – Multiple procedures.
• Modifier LT / RT – If payer accepts, to indicate laterality (left or right vulva).

Documentation Requirements

Accurate and detailed operative notes are essential for reimbursement and audit defense. Providers should document:

Checklist for Compliance:

• Clinical indication (VIN, carcinoma, non-healing lesion, etc.)
• Lesion details (location, size, description)
• Type and extent of vulvar tissue removed
• Surgical margins and closure technique
• Intraoperative findings
• Postoperative instructions and follow-up plan
• Pathology submission confirmation

Thorough notes not only support coding but also protect against denials and audits.

Example Scenarios

• Scenario 1 – VIN Removal
• A patient presents with VIN 3 on the labia minora. The surgeon performs a partial vulvectomy with clear margins. → Bill 56620.
• Scenario 2 – Early Vulvar Carcinoma
• A small carcinoma on the labia majora is surgically removed with a partial vulvectomy. → Bill 56620.
• Scenario 3 – Combined Procedure
• A patient undergoes a partial vulvectomy with a separate inguinal lymph node dissection. → Report 56620 plus lymph node code, with appropriate modifiers.

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OBGYN surgeries like partial vulvectomy require accurate coding, strict compliance, and strong documentation to ensure reimbursement. That’s where BillingFreedom comes in.

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For more details about our exceptional OB/GYN medical billing services, please don't hesitate to contact us via email at info@billingfreedom.com or call us at +1 (855) 415-3472. Your financial tranquility is our priority!