CPT code 56605: Vulvar biopsy, first lesion sampled2026 Medicare rate & RVUs in South Dakota
Report this procedure when a clinician samples a single vulvar or perineal lesion for tissue diagnosis rather than removing vulvar tissue definitively.
In South Dakota, Medicare pays $89.31 for 56605 in the office and $47.56 when it’s performed in a hospital or facility.
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.
On this page 11 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.
How South Dakota 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. South Dakota pays $89.31. The RVUs are the same everywhere; the geographic indexes change the dollars.
- South Dakota · this page$89.31
- Los Angeles, CA · California$102.27+$12.96
- Washington, DC area · District of Columbia$105.33+$16.02
- Miami, FL · Florida$105.33+$16.02
- Chicago, IL · Illinois$102.25+$12.94
- Manhattan, NY · New York$107.86+$18.55
- Alaska · Alaska$111.89+$22.58
Other areas in South Dakota first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| 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 |
| Madera, CACalifornia | $96.12 | $50.36 |
| Merced, CACalifornia | $96.12 | $50.36 |
| Modesto, CACalifornia | $96.12 | $50.36 |
| Napa, CACalifornia | $109.01 | $53.98 |
| Oxnard, CACalifornia | $101.49 | $52.14 |
| Redding, CACalifornia | $96.12 | $50.36 |
| Rest of CaliforniaCalifornia | $96.12 | $50.36 |
| Riverside, CACalifornia | $98.17 | $52.41 |
| Sacramento, CACalifornia | $100.25 | $51.69 |
| Salinas, CACalifornia | $99.86 | $51.47 |
| San Diego, CACalifornia | $101.77 | $51.84 |
| Marin County, CACalifornia | $114.57 | $55.70 |
| San Francisco, CACalifornia | $114.36 | $55.49 |
| San Benito County, CACalifornia | $117.24 | $57.04 |
| Santa Clara County, CACalifornia | $116.36 | $56.16 |
| San Luis Obispo, CACalifornia | $98.34 | $50.78 |
| Santa Cruz, CACalifornia | $102.39 | $51.66 |
| Santa Maria, CACalifornia | $100.12 | $51.44 |
| Santa Rosa, CACalifornia | $103.38 | $52.11 |
| Stockton, CACalifornia | $96.12 | $50.36 |
| Vallejo, CACalifornia | $108.70 | $53.67 |
| Visalia, CACalifornia | $96.12 | $50.36 |
| Yuba City, CACalifornia | $96.12 | $50.36 |
| ColoradoColorado | $95.85 | $51.43 |
| ConnecticutConnecticut | $99.53 | $54.56 |
| DelawareDelaware | $92.44 | $51.19 |
| Fort Lauderdale, FLFlorida | $99.32 | $57.03 |
| Rest of FloridaFlorida | $94.45 | $54.54 |
| Atlanta, GAGeorgia | $95.73 | $53.31 |
| Rest of GeorgiaGeorgia | $89.19 | $51.94 |
| Hawaii, Guam, HIHawaii | $97.90 | $50.43 |
| IowaIowa | $85.32 | $47.12 |
| IdahoIdaho | $86.06 | $47.65 |
| East St. Louis, ILIllinois | $95.84 | $57.43 |
| Rest of IllinoisIllinois | $92.62 | $54.50 |
| Suburban Chicago, ILIllinois | $100.06 | $57.18 |
| IndianaIndiana | $86.51 | $47.80 |
| KansasKansas | $85.44 | $47.69 |
| KentuckyKentucky | $87.27 | $50.16 |
| New Orleans, LALouisiana | $91.35 | $52.06 |
| Rest of LouisianaLouisiana | $87.34 | $50.39 |
| Metropolitan Boston, MAMassachusetts | $104.27 | $54.42 |
| Rest of MassachusettsMassachusetts | $95.53 | $51.57 |
| Baltimore area, MDMaryland | $99.35 | $54.55 |
| Rest of MarylandMaryland | $93.98 | $51.72 |
| Rest of MaineMaine | $87.01 | $48.60 |
| Southern Maine, MEMaine | $90.72 | $49.34 |
| Detroit, MIMichigan | $96.08 | $55.79 |
| Rest of MichiganMichigan | $89.87 | $51.75 |
| MinnesotaMinnesota | $90.55 | $47.58 |
| Metropolitan Kansas City, MOMissouri | $90.24 | $51.03 |
| Metropolitan St. Louis, MOMissouri | $91.07 | $51.32 |
| Rest of MissouriMissouri | $86.26 | $50.27 |
| MississippiMississippi | $84.72 | $48.77 |
| MontanaMontana | $93.51 | $51.76 |
| North CarolinaNorth Carolina | $87.79 | $48.83 |
| North DakotaNorth Dakota | $89.75 | $48.00 |
| NebraskaNebraska | $85.61 | $47.08 |
| New HampshireNew Hampshire | $94.84 | $51.38 |
| Northern New JerseyNew Jersey | $104.44 | $56.00 |
| Rest of New JerseyNew Jersey | $100.30 | $54.71 |
| New MexicoNew Mexico | $90.53 | $52.24 |
| NevadaNevada | $92.51 | $50.72 |
| NYC suburbs and Long Island, NYNew York | $110.97 | $61.33 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $101.35 | $55.63 |
| Queens, NYNew York | $107.98 | $58.63 |
| Rest of New YorkNew York | $89.07 | $49.40 |
| OhioOhio | $89.10 | $50.98 |
| OklahomaOklahoma | $86.60 | $49.32 |
| Portland, OROregon | $98.18 | $51.79 |
| Rest of OregonOregon | $91.43 | $49.85 |
| Metropolitan Philadelphia, PAPennsylvania | $97.50 | $54.04 |
| Rest of PennsylvaniaPennsylvania | $88.96 | $50.63 |
| Puerto RicoPuerto Rico | $93.99 | $51.78 |
| Rhode IslandRhode Island | $95.21 | $52.08 |
| South CarolinaSouth Carolina | $88.66 | $50.08 |
| TennesseeTennessee | $85.90 | $47.95 |
| Austin, TXTexas | $95.85 | $51.68 |
| Beaumont, TXTexas | $88.44 | $50.45 |
| Brazoria, TXTexas | $91.95 | $50.57 |
| Dallas, TXTexas | $92.74 | $51.15 |
| Fort Worth, TXTexas | $92.31 | $51.14 |
| Galveston, TXTexas | $92.36 | $50.90 |
| Houston, TXTexas | $95.83 | $54.38 |
| Rest of TexasTexas | $90.28 | $50.66 |
| UtahUtah | $89.79 | $50.54 |
| VirginiaVirginia | $90.78 | $49.74 |
| Virgin Islands, VIUnited States Virgin Islands | $93.99 | $51.78 |
| VermontVermont | $89.87 | $48.54 |
| Rest of WashingtonWashington | $95.20 | $51.23 |
| King County, WAWashington | $105.82 | $54.60 |
| WisconsinWisconsin | $86.97 | $46.97 |
| West VirginiaWest Virginia | $89.52 | $53.24 |
| WyomingWyoming | $91.87 | $50.12 |
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $111.89 | 1 |
| AL | $84.34 | 1 |
| AR | $83.19 | 1 |
| AZ | $91.01 | 1 |
| CA | $96.12–$117.24 | 29 |
| CO | $95.85 | 1 |
| CT | $99.53 | 1 |
| DC | $105.33 | 1 |
| DE | $92.44 | 1 |
| FL | $94.45–$105.33 | 3 |
| GA | $89.19–$95.73 | 2 |
| GU | $97.90 | 1 |
| HI | $97.90 | 1 |
| IA | $85.32 | 1 |
| ID | $86.06 | 1 |
| IL | $92.62–$102.25 | 4 |
| IN | $86.51 | 1 |
| KS | $85.44 | 1 |
| KY | $87.27 | 1 |
| LA | $87.34–$91.35 | 2 |
| MA | $95.53–$104.27 | 2 |
| MD | $93.98–$105.33 | 3 |
| ME | $87.01–$90.72 | 2 |
| MI | $89.87–$96.08 | 2 |
| MN | $90.55 | 1 |
| MO | $86.26–$91.07 | 3 |
| MS | $84.72 | 1 |
| MT | $93.51 | 1 |
| NC | $87.79 | 1 |
| ND | $89.75 | 1 |
| NE | $85.61 | 1 |
| NH | $94.84 | 1 |
| NJ | $100.30–$104.44 | 2 |
| NM | $90.53 | 1 |
| NV | $92.51 | 1 |
| NY | $89.07–$110.97 | 5 |
| OH | $89.10 | 1 |
| OK | $86.60 | 1 |
| OR | $91.43–$98.18 | 2 |
| PA | $88.96–$97.50 | 2 |
| PR | $93.99 | 1 |
| RI | $95.21 | 1 |
| SC | $88.66 | 1 |
| SD | $89.31 | 1 |
| TN | $85.90 | 1 |
| TX | $88.44–$95.85 | 8 |
| UT | $89.79 | 1 |
| VA | $90.78–$105.33 | 2 |
| VI | $93.99 | 1 |
| VT | $89.87 | 1 |
| WA | $95.20–$105.82 | 2 |
| WI | $86.97 | 1 |
| WV | $89.52 | 1 |
| WY | $91.87 | 1 |
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.
The exact South Dakota 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
94
- Locality
- South Dakota
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.336
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.07 | × 1.000 | 1.0700 |
| Practice expense | 1.54 | × 1.000 | 1.5400 |
| Malpractice | 0.19 | × 0.336 | 0.0638 |
| Total RVUs | 2.6738 | ||
| Conversion factor | × 33.4009 | ||
Office rate, South Dakota$89.31
Office: (1.07 × 1 + 1.54 × 1 + 0.19 × 0.336) × $33.4009 = $89.31
Facility: (1.07 × 1 + 0.29 × 1 + 0.19 × 0.336) × $33.4009 = $47.56
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%).
How 56605 has changed in South Dakota
56605 · Office / nonfacility
$89.31
Effective 2026-10-01
The base rate is $0.13 lower than on 2025-10-01, moving from $89.44 to $89.31 (0.1%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$89.44changed to$89.31
- 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
- Malpractice GPCI 0.382 changed to 0.336
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$93.16changed to$89.44
- 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.
March 9, 2024
RVU24AR
$91.64changed to$93.16
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$94.73changed to$91.64
- Conversion factor 33.8872 changed to 32.7442
- Malpractice GPCI 0.364 changed to 0.382
January 1, 2023
RVU23A
$96.29changed to$94.73
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 1.62 changed to 1.63
- Malpractice GPCI 0.347 changed to 0.364
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$93.71changed to$96.29
- 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.
January 1, 2021
RVU21A
$89.73changed to$93.71
- 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 0.368 changed to 0.347
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$84.49changed to$89.73
- 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
- Malpractice GPCI 0.389 changed to 0.368
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$80.80changed to$84.49
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 1.09 changed to 1.19
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$80.94changed to$80.80
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 1.10 changed to 1.09
- Malpractice GPCI 0.395 changed to 0.389
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$80.42changed to$80.94
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 1.09 changed to 1.10
- Malpractice GPCI 0.400 changed to 0.395
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$80.85changed to$80.42
- Conversion factor 35.9335 changed to 35.8043
- Malpractice RVU 0.15 changed to 0.14
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$80.45changed to$80.85
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$80.99changed to$80.45
- Conversion factor 35.8228 changed to 35.7547
- Malpractice RVU 0.17 changed to 0.15
- Malpractice GPCI 0.416 changed to 0.400
Held through RVU15B.
January 1, 2014
RVU14A
$80.56changed to$80.99
- 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
- Malpractice GPCI 0.432 changed to 0.416
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $80.56
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $89.31 | $47.56 | RVU26D |
| 2026-07-01 | $89.31 | $47.56 | RVU26C |
| 2026-04-01 | $89.31 | $47.56 | RVU26B |
| 2026-01-01 | $89.31 | $47.56 | RVU26A |
| 2025-10-01 | $89.44 | $53.85 | RVU25D |
| 2025-07-01 | $89.44 | $53.85 | RVU25C |
| 2025-04-01 | $89.44 | $53.85 | RVU25B |
| 2025-01-01 | $89.44 | $53.85 | RVU25A |
| 2024-10-01 | $93.16 | $55.22 | RVU24D |
| 2024-07-01 | $93.16 | $55.22 | RVU24C |
| 2024-04-01 | $93.16 | $55.22 | RVU24B |
| 2024-03-09 | $93.16 | $55.22 | RVU24AR |
| 2024-01-01 | $91.64 | $54.31 | RVU24A |
| 2023-10-01 | $94.73 | $56.10 | RVU23D |
| 2023-07-01 | $94.73 | $56.10 | RVU23C |
| 2023-04-01 | $94.73 | $56.10 | RVU23B |
| 2023-01-01 | $94.73 | $56.10 | RVU23A |
| 2022-10-01 | $96.29 | $56.49 | RVU22D |
| 2022-07-01 | $96.29 | $56.49 | RVU22C |
| 2022-04-01 | $96.29 | $56.49 | RVU22B |
| 2022-01-01 | $96.29 | $56.49 | RVU22A |
| 2021-10-01 | $93.71 | $57.07 | RVU21D |
| 2021-07-01 | $93.71 | $57.07 | RVU21C |
| 2021-04-01 | $93.71 | $57.07 | RVU21B |
| 2021-01-01 | $93.71 | $57.07 | RVU21A |
| 2020-10-01 | $89.73 | $59.05 | RVU20D |
| 2020-07-01 | $89.73 | $59.05 | RVU20C |
| 2020-04-01 | $89.73 | $59.05 | RVU20B |
| 2020-01-01 | $89.73 | $59.05 | RVU20A |
| 2019-10-01 | $84.49 | $58.54 | RVU19D |
| 2019-07-01 | $84.49 | $58.54 | RVU19C |
| 2019-04-01 | $84.49 | $58.54 | RVU19B |
| 2019-01-01 | $84.49 | $58.54 | RVU19A |
| 2018-10-01 | $80.80 | $58.84 | RVU18D |
| 2018-07-01 | $80.80 | $58.84 | RVU18C |
| 2018-04-01 | $80.80 | $58.84 | RVU18B |
| 2018-01-01 | $80.80 | $58.84 | RVU18AR1 |
| 2017-10-01 | $80.94 | $59.05 | RVU17D |
| 2017-07-01 | $80.94 | $59.05 | RVU17C |
| 2017-04-01 | $80.94 | $59.05 | RVU17B |
| 2017-01-01 | $80.94 | $59.05 | RVU17A |
| 2016-10-01 | $80.42 | $58.58 | RVU16D |
| 2016-07-01 | $80.42 | $58.58 | RVU16C |
| 2016-04-01 | $80.42 | $58.58 | RVU16B |
| 2016-01-01 | $80.42 | $58.58 | RVU16A |
| 2015-10-01 | $80.85 | $58.93 | RVU15D |
| 2015-07-01 | $80.85 | $58.93 | RVU15C |
| 2015-04-01 | $80.45 | $58.64 | RVU15B |
| 2015-01-01 | $80.45 | $58.64 | RVU15A |
| 2014-10-01 | $80.99 | $59.13 | RVU14D |
| 2014-07-01 | $80.99 | $59.13 | RVU14C |
| 2014-04-01 | $80.99 | $59.13 | RVU14B |
| 2014-01-01 | $80.99 | $59.13 | RVU14A |
| 2013-10-01 | $80.56 | $57.76 | RVU13D |
| 2013-07-01 | $80.56 | $57.76 | RVU13C |
| 2013-04-01 | $80.56 | $57.76 | RVU13B |
| 2013-01-01 | $80.56 | $57.76 | RVU13AR |
Where the South Dakota rate applies
South Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 485 cities and communities in South Dakota. Some span more than one payment area; confirm with the service ZIP.
- Aberdeen
- Agar
- Agency Village
- Akaska
- Albee
- Alcester
- Alexandria
- Allen
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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