CPT code 56605: Vulvar biopsy, first lesion sampled2026 Medicare rate & RVUs in California
Report this procedure when a clinician samples a single vulvar or perineal lesion for tissue diagnosis rather than removing vulvar tissue definitively.
Medicare pays $96.12–$117.24 for 56605 in the office in California, from Chico, CA to San Benito County, CA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 56605 covers
A clinician takes tissue from one vulvar or perineal lesion for histopathologic evaluation, often using a punch or incisional sample when examination findings or symptoms warrant diagnosis. Gynecologists and other clinicians managing vulvar disease may perform the biopsy in an office procedure room or facility. Common reasons include evaluating a persistent ulcer, an abnormal pigmented area, focal thickening, or a lesion concerning for vulvar intraepithelial neoplasia or malignancy.
Report 56605 for the first lesion sampled and 56606 for each additional separately biopsied lesion. Document the lesion site and number, the clinical reason for sampling, and the biopsy performed. The 0-day global period includes same-day preoperative and postoperative care. When multiple procedures are performed in the same session, the highest-valued is paid in full and others are subject to the standard 50% reduction. Modifier 50 is inappropriate, even for lesions on both sides. CMS does not pay an assistant at surgery for this service; co-surgeons are permitted, but team surgery is not.
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.
Where 56605 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$96.12 to $117.24
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $96.66 | $50.90 |
| Chico, CA | $96.12 | $50.36 |
| El Centro, CA | $96.16 | $50.40 |
| Fresno, CA | $96.12 | $50.36 |
| Hanford, CA | $96.12 | $50.36 |
| Los Angeles, CA | $102.27 | $52.88 |
| Madera, CA | $96.12 | $50.36 |
| Marin County, CA | $114.57 | $55.70 |
| Merced, CA | $96.12 | $50.36 |
| Modesto, CA | $96.12 | $50.36 |
| Napa, CA | $109.01 | $53.98 |
| Oxnard, CA | $101.49 | $52.14 |
| Redding, CA | $96.12 | $50.36 |
| Rest of California | $96.12 | $50.36 |
| Riverside, CA | $98.17 | $52.41 |
| Sacramento, CA | $100.25 | $51.69 |
| Salinas, CA | $99.86 | $51.47 |
| San Benito County, CA | $117.24 | $57.04 |
| San Diego, CA | $101.77 | $51.84 |
| San Francisco, CA | $114.36 | $55.49 |
| San Luis Obispo, CA | $98.34 | $50.78 |
| Santa Clara County, CA | $116.36 | $56.16 |
| Santa Cruz, CA | $102.39 | $51.66 |
| Santa Maria, CA | $100.12 | $51.44 |
| Santa Rosa, CA | $103.38 | $52.11 |
| Stockton, CA | $96.12 | $50.36 |
| Vallejo, CA | $108.70 | $53.67 |
| Visalia, CA | $96.12 | $50.36 |
| Yuba City, CA | $96.12 | $50.36 |
How the 56605 rate is calculated
Each of 56605’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 · 56605
RVUs × geographic indexes × conversion factor
Work1.07
1.07 RVUs× 1.000 GPCI
Practice expense1.54
1.54 RVUs× 1.000 GPCI
Malpractice0.19
0.19 RVUs× 1.000 GPCI
Adjusted RVUs
2.8000
Conversion factor
$33.4009
Medicare rate
$93.52
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 56605
The CMS indicators that decide how 56605 is paid alongside other services.
CMS payment indicators · 56605
Vulvar biopsy, first lesion sampled
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 2 | Permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
56605 without 51 · national office
$93.52
Vulvar biopsy, first lesion sampled
56605-51 · Second procedure: 50%
$46.76
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%).
56605 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 56606Vulvar biopsyEach additional lesion
- 56605 covers the first lesion sampled; 56606 reports each additional separately biopsied lesion.
- 56821Vulvar colposcopyWith biopsy
- Choose 56821 when vulvar colposcopy with biopsy is performed; 56605 describes biopsy without that colposcopy service.
- 56620VulvectomySimple, partial excision
- 56620 describes definitive partial vulvar removal. Use 56605 when tissue is sampled for diagnosis rather than removing vulvar tissue as treatment.
56605 billing questions
When should 56606 be reported instead?
Use 56605 for the first lesion biopsied. Report 56606 for each additional, separately sampled lesion.
Can modifier 50 be used for lesions on both sides?
No. The bilateral adjustment does not apply, and modifier 50 is inappropriate for this service.
Is the pathology examination included?
The code covers obtaining the biopsy tissue. Histologic examination is a separate laboratory service when performed and reported by the responsible laboratory.
What documentation supports the code?
Record the vulvar or perineal site, the number of lesions sampled, the clinical reason for biopsy, and the procedure performed.
How does CMS handle other procedures performed in the same session?
The highest-valued procedure is paid in full, with the other procedures subject to the standard multiple procedure reduction. Same-day preoperative and postoperative care is included in the 0-day global period.
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
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