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CPT code 56405: Abscess drainage, vulva or perineum2026 Medicare rate & RVUs in Washington, DC area

Reports incision and drainage of an abscess in the vulva or perineum, excluding a Bartholin gland abscess coded to its specific procedure.

CMS RVU26DEffective Oct 1, 2026One payment locality4.9K Medicare services in 2024

In Washington, DC area, Medicare pays $165.37 for 56405 in the office and $131.14 when it’s performed in a hospital or facility.

$165.37Office (non-facility)
$131.14Hospital or facility
+13.3%vs the national office rate ($145.96)

Check a contract rate as a % of Medicare · 56405 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 56405 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Washington, DC area
  2. What 56405 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 56405 covers

A clinician incises and drains a localized collection of pus in the vulvar or perineal tissues. The service may be performed by a gynecologist, family physician, or other qualified clinician in an office or facility setting. A vulvar soft-tissue abscess is an example; an abscess of the Bartholin gland has its own code. The documented site should distinguish the treated abscess from a Bartholin gland abscess and from an abscess elsewhere on the skin.

Report 56405 when the abscess is in the vulva or perineum and the service is incision and drainage. The record should identify the anatomic location and describe the drainage procedure. Related postoperative visits during the 10-day global period are included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery; co-surgeons are permitted, while team surgery is not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Washington, DC area compares for 56405

Across 109 of 109 payment localities, the office rate for 56405 runs from $129.22 in Arkansas to $186.53 in San Benito County, CA. Washington, DC area pays $165.37. The RVUs are the same everywhere; the geographic indexes change the dollars.

56405 in Washington, DC area vs other payment areas
  1. Washington, DC area · this page$165.37
  2. Los Angeles, CA · California$161.29−$4.08
  3. Miami, FL · Florida$162.88−$2.49
  4. Chicago, IL · Illinois$157.99−$7.38
  5. Manhattan, NY · New York$168.54+$3.17
  6. Alaska · Alaska$172.05+$6.68
  7. Alabama · Alabama$131.09−$34.28

Other areas in District of Columbia first, then benchmark localities. Bars start at $0.

Every other payment area

56405 in every other Medicare payment locality
Payment localityOfficeFacility
ArkansasArkansas$129.22$104.26
ArizonaArizona$141.96$113.80
Bakersfield, CACalifornia$152.02$120.17
Chico, CACalifornia$151.29$119.44
El Centro, CACalifornia$151.33$119.48
Fresno, CACalifornia$151.29$119.44
Hanford, CACalifornia$151.29$119.44
Madera, CACalifornia$151.29$119.44

56405 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$129.22

$172.05

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
56405 office rate range by state
State / territoryOffice rate rangeLocalities
AK$172.051
AL$131.091
AR$129.221
AZ$141.961
CA$151.29–$186.5329
CO$150.331
CT$155.601
DC$165.371
DE$144.261
FL$146.42–$162.883
GA$138.03–$149.272
GU$154.481
HI$154.481
IA$133.171
ID$134.281
IL$143.12–$157.994
IN$135.011
KS$133.131
KY$135.361
LA$135.38–$141.902
MA$149.68–$164.232
MD$146.80–$165.373
ME$135.57–$141.962
MI$139.35–$148.812
MN$142.421
MO$133.48–$141.713
MS$131.351
MT$145.941
NC$136.871
ND$140.801
NE$133.721
NH$148.521
NJ$156.92–$163.822
NM$140.331
NV$144.601
NY$138.94–$173.305
OH$138.301
OK$134.521
OR$143.03–$154.382
PA$138.20–$152.152
PR$146.811
RI$148.881
SC$137.911
SD$140.201
TN$133.861
TX$137.35–$150.228
UT$139.751
VA$141.90–$165.372
VI$146.811
VT$140.781
WA$149.22–$166.962
WI$136.221
WV$138.071
WY$143.701

See 56405 in every payment locality

How the 56405 rate is calculated

Each of 56405’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 56405

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.45

1.45 RVUs× 1.000 GPCI

Practice expense2.66

2.66 RVUs× 1.000 GPCI

Malpractice0.26

0.26 RVUs× 1.000 GPCI

Adjusted RVUs

4.3700

Conversion factor

$33.4009

Medicare rate

$145.96

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Washington, DC area inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

6,403

Code
56405
Physician work
1.45
Practice expense
2.66
Malpractice
0.26

GPCI2026.csv

39

Locality
Washington, DC area
Physician work
1.054
Practice expense
1.178
Malpractice
1.113
Office calculation for 56405 in Washington, DC area
ComponentRVULocality factorAdjusted
Physician work1.45× 1.0541.5283
Practice expense2.66× 1.1783.1335
Malpractice0.26× 1.1130.2894
Total RVUs4.9512
Conversion factor× 33.4009

Office rate, Washington, DC area$165.37

Office: (1.45 × 1.054 + 2.66 × 1.178 + 0.26 × 1.113) × $33.4009 = $165.37

Facility: (1.45 × 1.054 + 1.79 × 1.178 + 0.26 × 1.113) × $33.4009 = $131.14

Open 56405 in the RVU calculator

Payment rules and modifiers for 56405

56405 has a 10-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 56405

Abscess drainage, vulva or perineum

RuleCMS valueWhat it means
Global period010Minor procedure: the day of the procedure plus 10 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)2Permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.80/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 56405

Abscess drainage, vulva or perineum

10-day global period ends

Oct 11, 2026

Covers Oct 1, 2026 through Oct 11, 2026 (11 days).

Visit on Oct 31, 2026

After the global period ends: visits and procedures are billed normally.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

56405 without 51 · national office

$145.96

Abscess drainage, vulva or perineum

56405-51 · Second procedure: 50%

$72.98

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

Codes related to 56405

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 56405
CodeHow it relatesOffice range, Washington, DC area
Used instead
56420Abscess drainage, bartholin glandUse for drainage of a Bartholin gland abscess rather than a vulvar or perineal soft-tissue abscess.$208.12
10060Abscess drainage, simple, single abscessGeneral incision and drainage code for a simple or single abscess at a site not represented by 56405.$146.27
10061Abscess drainage, complex or multipleGeneral incision and drainage code for complicated or multiple abscesses at sites not represented by 56405.$248.68

How 56405 has changed in Washington, DC area

56405 · Office / nonfacility

$165.37

Effective 2026-10-01

The base rate is $3.21 higher than on 2025-10-01, moving from $162.16 to $165.37 (2.0%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $162.16changed to$165.37

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.49 changed to 1.45
    • Practice expense RVU 2.62 changed to 2.66
    • Malpractice RVU 0.27 changed to 0.26
    • Work GPCI 1.057 changed to 1.054
    • Practice expense GPCI 1.192 changed to 1.178
    • Malpractice GPCI 1.168 changed to 1.113

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $169.28changed to$162.16

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 2.70 changed to 2.62
    • Malpractice RVU 0.25 changed to 0.27

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $166.52changed to$169.28

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $175.65changed to$166.52

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 2.72 changed to 2.70
    • Work GPCI 1.056 changed to 1.057
    • Practice expense GPCI 1.214 changed to 1.192
    • Malpractice GPCI 1.231 changed to 1.168

  5. January 1, 2023

    RVU23A

    $182.31changed to$175.65

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 2.73 changed to 2.72
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.236 changed to 1.214
    • Malpractice GPCI 1.294 changed to 1.231

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $171.32changed to$182.31

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 2.44 changed to 2.73

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $153.88changed to$171.32

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.94 changed to 2.44
    • Malpractice RVU 0.26 changed to 0.25
    • Work GPCI 1.049 changed to 1.054
    • Practice expense GPCI 1.221 changed to 1.236
    • Malpractice GPCI 1.277 changed to 1.294

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $132.93changed to$153.88

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.57 changed to 1.94
    • Malpractice RVU 0.19 changed to 0.26
    • Work GPCI 1.045 changed to 1.049
    • Practice expense GPCI 1.205 changed to 1.221
    • Malpractice GPCI 1.261 changed to 1.277

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $126.28changed to$132.93

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.42 changed to 1.57

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $126.55changed to$126.28

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.43 changed to 1.42
    • Work GPCI 1.048 changed to 1.045
    • Malpractice GPCI 1.271 changed to 1.261

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $125.61changed to$126.55

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.41 changed to 1.43
    • Work GPCI 1.051 changed to 1.048
    • Malpractice GPCI 1.280 changed to 1.271

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $127.42changed to$125.61

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 1.42 changed to 1.41
    • Malpractice RVU 0.21 changed to 0.19

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $126.78changed to$127.42

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $127.55changed to$126.78

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 1.41 changed to 1.42
    • Malpractice RVU 0.25 changed to 0.21
    • Work GPCI 1.050 changed to 1.051
    • Practice expense GPCI 1.202 changed to 1.205
    • Malpractice GPCI 1.205 changed to 1.280

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $126.35changed to$127.55

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 1.55 changed to 1.41
    • Malpractice RVU 0.26 changed to 0.25
    • Work GPCI 1.049 changed to 1.050
    • Practice expense GPCI 1.198 changed to 1.202
    • Malpractice GPCI 1.130 changed to 1.205

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $126.35

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$165.37$131.14RVU26D
2026-07-01$165.37$131.14RVU26C
2026-04-01$165.37$131.14RVU26B
2026-01-01$165.37$131.14RVU26A
2025-10-01$162.16$141.73RVU25D
2025-07-01$162.16$141.73RVU25C
2025-04-01$162.16$141.73RVU25B
2025-01-01$162.16$141.73RVU25A
2024-10-01$169.28$145.87RVU24D
2024-07-01$169.28$145.87RVU24C
2024-04-01$169.28$145.87RVU24B
2024-03-09$169.28$145.87RVU24AR
2024-01-01$166.52$143.49RVU24A
2023-10-01$175.65$149.73RVU23D
2023-07-01$175.65$149.73RVU23C
2023-04-01$175.65$149.73RVU23B
2023-01-01$175.65$149.73RVU23A
2022-10-01$182.31$153.66RVU22D
2022-07-01$182.31$153.66RVU22C
2022-04-01$182.31$153.66RVU22B
2022-01-01$182.31$153.66RVU22A
2021-10-01$171.32$149.32RVU21D
2021-07-01$171.32$149.32RVU21C
2021-04-01$171.32$149.32RVU21B
2021-01-01$171.32$149.32RVU21A
2020-10-01$153.88$142.42RVU20D
2020-07-01$153.88$142.42RVU20C
2020-04-01$153.88$142.42RVU20B
2020-01-01$153.88$142.42RVU20A
2019-10-01$132.93$131.63RVU19D
2019-07-01$132.93$131.63RVU19C
2019-04-01$132.93$131.63RVU19B
2019-01-01$132.93$131.63RVU19A
2018-10-01$126.28$125.41RVU18D
2018-07-01$126.28$125.41RVU18C
2018-04-01$126.28$125.41RVU18B
2018-01-01$126.28$125.41RVU18AR1
2017-10-01$126.55$125.68RVU17D
2017-07-01$126.55$125.68RVU17C
2017-04-01$126.55$125.68RVU17B
2017-01-01$126.55$125.68RVU17A
2016-10-01$125.61$124.75RVU16D
2016-07-01$125.61$124.75RVU16C
2016-04-01$125.61$124.75RVU16B
2016-01-01$125.61$124.75RVU16A
2015-10-01$127.42$126.55RVU15D
2015-07-01$127.42$126.55RVU15C
2015-04-01$126.78$125.92RVU15B
2015-01-01$126.78$125.92RVU15A
2014-10-01$127.55$126.69RVU14D
2014-07-01$127.55$126.69RVU14C
2014-04-01$127.55$126.69RVU14B
2014-01-01$127.55$126.69RVU14A
2013-10-01$126.35$125.54RVU13D
2013-07-01$126.35$125.54RVU13C
2013-04-01$126.35$125.54RVU13B
2013-01-01$126.35$125.54RVU13AR

Price 56405 for an earlier date of service

Where the Washington, DC area rate applies

Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.

  • Washington

Browse all communities in District of Columbia

56405 billing questions

When should 56405 be used instead of 56420?

Use 56405 for an abscess in vulvar or perineal tissue. Use 56420 when the abscess involves the Bartholin gland.

What documentation supports 56405?

Document the abscess location in the vulva or perineum and the incision-and-drainage service performed. Clarify whether the Bartholin gland is involved.

Can modifier 50 be reported?

No. The descriptor and anatomy make modifier 50 inappropriate for this code.

Are related postoperative visits separately reported?

Related postoperative visits during the 10-day global period are included in the procedure.

How are other procedures in the same session paid?

The highest-valued procedure is paid in full; other procedures are subject to the standard multiple procedure reduction.

Can an assistant or co-surgeon be reported?

Medicare does not pay an assistant at surgery for this code. Co-surgeons are permitted, but team surgery is not.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 56405PPRRVU2026_Oct_nonQPP.csv, line 6,403 (RVU26D)
Geographic factors for Washington, DC areaGPCI2026.csv, line 39 (RVU26D)

Open CMS sourceHow we calculate rates

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