CPT code 56605: Vulvar biopsy, first lesion sampled2026 Medicare rate & RVUs in Puerto Rico

Report this procedure when a clinician samples a single vulvar or perineal lesion for tissue diagnosis rather than removing vulvar tissue definitively.

CMS RVU26DEffective Oct 1, 2026One payment locality26.3K Medicare services in 2024

In Puerto Rico, Medicare pays $93.99 for 56605 in the office and $51.78 when it’s performed in a hospital or facility.

$93.99Office (non-facility)
$51.78Hospital or facility
+0.5%vs the national office rate ($93.52)

Check a contract rate as a % of Medicare · 56605 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 56605 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 56605 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 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.

How Puerto Rico compares for 56605

Across 109 of 109 payment localities, the office rate for 56605 runs from $83.19 in Arkansas to $117.24 in San Benito County, CA. Puerto Rico pays $93.99. The RVUs are the same everywhere; the geographic indexes change the dollars.

56605 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$93.99
  2. Los Angeles, CA · California$102.27+$8.28
  3. Washington, DC area · District of Columbia$105.33+$11.34
  4. Miami, FL · Florida$105.33+$11.34
  5. Chicago, IL · Illinois$102.25+$8.26
  6. Manhattan, NY · New York$107.86+$13.87
  7. Alaska · Alaska$111.89+$17.90

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

Every other payment area

56605 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$84.34$47.81
ArkansasArkansas$83.19$47.33
ArizonaArizona$91.01$50.56
Bakersfield, CACalifornia$96.66$50.90
Chico, CACalifornia$96.12$50.36
El Centro, CACalifornia$96.16$50.40
Fresno, CACalifornia$96.12$50.36
Hanford, CACalifornia$96.12$50.36

56605 rates by state

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

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.

$83.19

$111.89

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

View every state and territory as a table
56605 office rate range by state
State / territoryOffice rate rangeLocalities
AK$111.891
AL$84.341
AR$83.191
AZ$91.011
CA$96.12–$117.2429
CO$95.851
CT$99.531
DC$105.331
DE$92.441
FL$94.45–$105.333
GA$89.19–$95.732
GU$97.901
HI$97.901
IA$85.321
ID$86.061
IL$92.62–$102.254
IN$86.511
KS$85.441
KY$87.271
LA$87.34–$91.352
MA$95.53–$104.272
MD$93.98–$105.333
ME$87.01–$90.722
MI$89.87–$96.082
MN$90.551
MO$86.26–$91.073
MS$84.721
MT$93.511
NC$87.791
ND$89.751
NE$85.611
NH$94.841
NJ$100.30–$104.442
NM$90.531
NV$92.511
NY$89.07–$110.975
OH$89.101
OK$86.601
OR$91.43–$98.182
PA$88.96–$97.502
PR$93.991
RI$95.211
SC$88.661
SD$89.311
TN$85.901
TX$88.44–$95.858
UT$89.791
VA$90.78–$105.332
VI$93.991
VT$89.871
WA$95.20–$105.822
WI$86.971
WV$89.521
WY$91.871

See 56605 in every payment locality

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

Office or facility?

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.

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

6,410

Code
56605
Physician work
1.07
Practice expense
1.54
Malpractice
0.19

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 56605 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work1.07× 1.0001.0700
Practice expense1.54× 1.0111.5569
Malpractice0.19× 0.9850.1872
Total RVUs2.8141
Conversion factor× 33.4009

Office rate, Puerto Rico$93.99

Office: (1.07 × 1 + 1.54 × 1.011 + 0.19 × 0.985) × $33.4009 = $93.99

Facility: (1.07 × 1 + 0.29 × 1.011 + 0.19 × 0.985) × $33.4009 = $51.78

Open 56605 in the RVU calculator

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

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is 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.

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%).

When to use modifier 51

How 56605 has changed in Puerto Rico

56605 · Office / nonfacility

$93.99

Effective 2026-10-01

The base rate is $0.89 higher than on 2025-10-01, moving from $93.10 to $93.99 (1.0%).

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

    $93.10changed to$93.99

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.10 changed to 1.07
    • Practice expense RVU 1.60 changed to 1.54
    • Malpractice RVU 0.17 changed to 0.19
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $97.14changed to$93.10

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 1.63 changed to 1.60
    • Malpractice RVU 0.18 changed to 0.17

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $95.55changed to$97.14

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $98.96changed to$95.55

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982
  5. October 1, 2023

    RVU23D

    $98.61changed to$98.96

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984
  6. January 1, 2023

    RVU23A

    $100.72changed to$98.61

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 1.62 changed to 1.63
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $97.70changed to$100.72

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 1.53 changed to 1.62
    • Malpractice RVU 0.16 changed to 0.18

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $94.14changed to$97.70

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.32 changed to 1.53
    • Malpractice RVU 0.18 changed to 0.16
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $87.82changed to$94.14

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.19 changed to 1.32
    • Malpractice RVU 0.14 changed to 0.18
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $84.10changed to$87.82

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.09 changed to 1.19

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $76.50changed to$84.10

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.10 changed to 1.09
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $68.37changed to$76.50

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.09 changed to 1.10
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $68.72changed to$68.37

    • Conversion factor 35.9335 changed to 35.8043
    • Malpractice RVU 0.15 changed to 0.14

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $68.38changed to$68.72

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $68.08changed to$68.38

    • Conversion factor 35.8228 changed to 35.7547
    • Malpractice RVU 0.17 changed to 0.15
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $66.40changed to$68.08

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 1.19 changed to 1.09
    • Malpractice RVU 0.18 changed to 0.17
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $66.40

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$93.99$51.78RVU26D
2026-07-01$93.99$51.78RVU26C
2026-04-01$93.99$51.78RVU26B
2026-01-01$93.99$51.78RVU26A
2025-10-01$93.10$57.27RVU25D
2025-07-01$93.10$57.27RVU25C
2025-04-01$93.10$57.27RVU25B
2025-01-01$93.10$57.27RVU25A
2024-10-01$97.14$58.93RVU24D
2024-07-01$97.14$58.93RVU24C
2024-04-01$97.14$58.93RVU24B
2024-03-09$97.14$58.93RVU24AR
2024-01-01$95.55$57.96RVU24A
2023-10-01$98.96$60.02RVU23D
2023-07-01$98.61$59.98RVU23C
2023-04-01$98.61$59.98RVU23B
2023-01-01$98.61$59.98RVU23A
2022-10-01$100.72$60.60RVU22D
2022-07-01$100.72$60.60RVU22C
2022-04-01$100.72$60.60RVU22B
2022-01-01$100.72$60.60RVU22A
2021-10-01$97.70$60.77RVU21D
2021-07-01$97.70$60.77RVU21C
2021-04-01$97.70$60.77RVU21B
2021-01-01$97.70$60.77RVU21A
2020-10-01$94.14$63.21RVU20D
2020-07-01$94.14$63.21RVU20C
2020-04-01$94.14$63.21RVU20B
2020-01-01$94.14$63.21RVU20A
2019-10-01$87.82$61.69RVU19D
2019-07-01$87.82$61.69RVU19C
2019-04-01$87.82$61.69RVU19B
2019-01-01$87.82$61.69RVU19A
2018-10-01$84.10$61.99RVU18D
2018-07-01$84.10$61.99RVU18C
2018-04-01$84.10$61.99RVU18B
2018-01-01$84.10$61.99RVU18AR1
2017-10-01$76.50$57.76RVU17D
2017-07-01$76.50$57.76RVU17C
2017-04-01$76.50$57.76RVU17B
2017-01-01$76.50$57.76RVU17A
2016-10-01$68.37$52.97RVU16D
2016-07-01$68.37$52.97RVU16C
2016-04-01$68.37$52.97RVU16B
2016-01-01$68.37$52.97RVU16A
2015-10-01$68.72$53.27RVU15D
2015-07-01$68.72$53.27RVU15C
2015-04-01$68.38$53.00RVU15B
2015-01-01$68.38$53.00RVU15A
2014-10-01$68.08$52.95RVU14D
2014-07-01$68.08$52.95RVU14C
2014-04-01$68.08$52.95RVU14B
2014-01-01$68.08$52.95RVU14A
2013-10-01$66.40$50.95RVU13D
2013-07-01$66.40$50.95RVU13C
2013-04-01$66.40$50.95RVU13B
2013-01-01$66.40$50.95RVU13AR

Price 56605 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

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
RVUs for 56605PPRRVU2026_Oct_nonQPP.csv, line 6,410 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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