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CPT code 56405: Abscess drainage, vulva or perineum2026 Medicare rate & RVUs in Wisconsin

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 Wisconsin, Medicare pays $136.22 for 56405 in the office and $108.38 when it’s performed in a hospital or facility.

$136.22Office (non-facility)
$108.38Hospital or facility
−6.7%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 Wisconsin
  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 Wisconsin 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. Wisconsin pays $136.22. The RVUs are the same everywhere; the geographic indexes change the dollars.

56405 in Wisconsin vs other payment areas
  1. Wisconsin · this page$136.22
  2. Los Angeles, CA · California$161.29+$25.07
  3. Washington, DC area · District of Columbia$165.37+$29.15
  4. Miami, FL · Florida$162.88+$26.66
  5. Chicago, IL · Illinois$157.99+$21.77
  6. Manhattan, NY · New York$168.54+$32.32
  7. Alaska · Alaska$172.05+$35.83

Other areas in Wisconsin first, then benchmark localities. Bars start at $0.

Every other payment area

56405 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$131.09$105.66
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

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 Wisconsin 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

111

Locality
Wisconsin
Physician work
1.000
Practice expense
0.958
Malpractice
0.308
Office calculation for 56405 in Wisconsin
ComponentRVULocality factorAdjusted
Physician work1.45× 1.0001.4500
Practice expense2.66× 0.9582.5483
Malpractice0.26× 0.3080.0801
Total RVUs4.0784
Conversion factor× 33.4009

Office rate, Wisconsin$136.22

Office: (1.45 × 1 + 2.66 × 0.958 + 0.26 × 0.308) × $33.4009 = $136.22

Facility: (1.45 × 1 + 1.79 × 0.958 + 0.26 × 0.308) × $33.4009 = $108.38

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, Wisconsin
Used instead
56420Abscess drainage, bartholin glandUse for drainage of a Bartholin gland abscess rather than a vulvar or perineal soft-tissue abscess.$171.14
10060Abscess drainage, simple, single abscessGeneral incision and drainage code for a simple or single abscess at a site not represented by 56405.$122.04
10061Abscess drainage, complex or multipleGeneral incision and drainage code for complicated or multiple abscesses at sites not represented by 56405.$207.06

How 56405 has changed in Wisconsin

56405 · Office / nonfacility

$136.22

Effective 2026-10-01

The base rate is $4.03 higher than on 2025-10-01, moving from $132.19 to $136.22 (3.0%).

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

    $132.19changed to$136.22

    • 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
    • Practice expense GPCI 0.957 changed to 0.958
    • Malpractice GPCI 0.331 changed to 0.308

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $138.36changed to$132.19

    • 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

    $136.11changed to$138.36

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $140.72changed to$136.11

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 2.72 changed to 2.70
    • Practice expense GPCI 0.950 changed to 0.957
    • Malpractice GPCI 0.314 changed to 0.331

  5. January 1, 2023

    RVU23A

    $143.12changed to$140.72

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 2.73 changed to 2.72
    • Practice expense GPCI 0.942 changed to 0.950
    • Malpractice GPCI 0.296 changed to 0.314

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $134.77changed to$143.12

    • 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

    $123.24changed to$134.77

    • 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
    • Practice expense GPCI 0.949 changed to 0.942
    • Malpractice GPCI 0.322 changed to 0.296

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $110.22changed to$123.24

    • 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
    • Practice expense GPCI 0.957 changed to 0.949
    • Malpractice GPCI 0.347 changed to 0.322

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $104.93changed to$110.22

    • 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

    $105.65changed to$104.93

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.43 changed to 1.42
    • Practice expense GPCI 0.956 changed to 0.957
    • Malpractice GPCI 0.457 changed to 0.347

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $105.41changed to$105.65

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.41 changed to 1.43
    • Practice expense GPCI 0.955 changed to 0.956
    • Malpractice GPCI 0.566 changed to 0.457

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $106.54changed to$105.41

    • 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

    $106.01changed to$106.54

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $106.75changed to$106.01

    • 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
    • Practice expense GPCI 0.958 changed to 0.955
    • Malpractice GPCI 0.557 changed to 0.566

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $106.16changed to$106.75

    • 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
    • Practice expense GPCI 0.960 changed to 0.958
    • Malpractice GPCI 0.547 changed to 0.557

    Held through RVU14B, RVU14C, RVU14D.

  16. October 1, 2013

    RVU13D

    No ratechanged to$106.16

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$136.22$108.38RVU26D
2026-07-01$136.22$108.38RVU26C
2026-04-01$136.22$108.38RVU26B
2026-01-01$136.22$108.38RVU26A
2025-10-01$132.19$115.78RVU25D
2025-07-01$132.19$115.78RVU25C
2025-04-01$132.19$115.78RVU25B
2025-01-01$132.19$115.78RVU25A
2024-10-01$138.36$119.57RVU24D
2024-07-01$138.36$119.57RVU24C
2024-04-01$138.36$119.57RVU24B
2024-03-09$138.36$119.57RVU24AR
2024-01-01$136.11$117.62RVU24A
2023-10-01$140.72$120.44RVU23D
2023-07-01$140.72$120.44RVU23C
2023-04-01$140.72$120.44RVU23B
2023-01-01$140.72$120.44RVU23A
2022-10-01$143.12$121.28RVU22D
2022-07-01$143.12$121.28RVU22C
2022-04-01$143.12$121.28RVU22B
2022-01-01$143.12$121.28RVU22A
2021-10-01$134.77$118.01RVU21D
2021-07-01$134.77$118.01RVU21C
2021-04-01$134.77$118.01RVU21B
2021-01-01$134.77$118.01RVU21A
2020-10-01$123.24$114.33RVU20D
2020-07-01$123.24$114.33RVU20C
2020-04-01$123.24$114.33RVU20B
2020-01-01$123.24$114.33RVU20A
2019-10-01$110.22$109.19RVU19D
2019-07-01$110.22$109.19RVU19C
2019-04-01$110.22$109.19RVU19B
2019-01-01$110.22$109.19RVU19A
2018-10-01$104.93$104.25RVU18D
2018-07-01$104.93$104.25RVU18C
2018-04-01$104.93$104.25RVU18B
2018-01-01$104.93$104.25RVU18AR1
2017-10-01$105.65$104.97RVU17D
2017-07-01$105.65$104.97RVU17C
2017-04-01$105.65$104.97RVU17B
2017-01-01$105.65$104.97RVU17A
2016-10-01$105.41$104.73RVU16D
2016-07-01$105.41$104.73RVU16C
2016-04-01$105.41$104.73RVU16B
2016-01-01$105.41$104.73RVU16A
2015-10-01$106.54$105.86RVU15D
2015-07-01$106.54$105.86RVU15C
2015-04-01$106.01$105.33RVU15B
2015-01-01$106.01$105.33RVU15A
2014-10-01$106.75$106.07RVU14D
2014-07-01$106.75$106.07RVU14C
2014-04-01$106.75$106.07RVU14B
2014-01-01$106.75$106.07RVU14A
2013-10-01$106.16$105.51RVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 56405 for an earlier date of service

Where the Wisconsin rate applies

Wisconsin is a Medicare payment area, not a city. Our Census mapping connects it to 807 cities and communities in Wisconsin. Some span more than one payment area; confirm with the service ZIP.

  • Abbotsford
  • Abrams
  • Adams
  • Adell
  • Albany
  • Algoma
  • Allens Grove
  • Allenton

Browse all communities in Wisconsin

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 WisconsinGPCI2026.csv, line 111 (RVU26D)

Open CMS sourceHow we calculate rates

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