CPT code 56606: Vulvar biopsy, each additional lesion2026 Medicare rate & RVUs in Missouri
Reports biopsy sampling of each additional vulvar or perineal lesion after the primary lesion biopsy, such as when several distinct lesions require tissue diagnosis.
Medicare pays $36.51–$38.22 for 56606 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. 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 56606 covers
This add-on represents tissue sampling from an additional, distinct lesion of the vulva or perineum after the primary lesion has been biopsied. A gynecologist or another clinician performing vulvar evaluation may obtain the specimen in an office, procedure room, or operating room. The tissue is typically submitted for histopathologic examination to investigate findings such as a persistent lesion or an area of abnormal vulvar tissue.
Report 56606 with the primary biopsy code 56605, not by itself, when a separate additional lesion is sampled. The record should identify the lesions and support that more than one distinct site was biopsied; repeated sampling of the same lesion is not an additional lesion. CMS classifies 56606 as an add-on code: it is billed only with a primary procedure and paid within that procedure's global period. The code does not represent a vulvectomy or removal of a larger area of vulvar tissue.
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 56606 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$36.51 to $38.22
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $37.91 | $25.05 |
| Metropolitan St. Louis, MO | $38.22 | $25.18 |
| Rest of Missouri | $36.51 | $24.71 |
How the 56606 rate is calculated
Each of 56606’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 · 56606
RVUs × geographic indexes × conversion factor
Work0.54
0.54 RVUs× 1.000 GPCI
Practice expense0.54
0.54 RVUs× 1.000 GPCI
Malpractice0.09
0.09 RVUs× 1.000 GPCI
Adjusted RVUs
1.1700
Conversion factor
$33.4009
Medicare rate
$39.08
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 56606
The CMS indicators that decide how 56606 is paid alongside other services.
CMS payment indicators · 56606
Vulvar biopsy, each additional lesion
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| 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. |
56606 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 56605Vulvar biopsyFirst lesion sampled
- 56605 reports the primary vulvar or perineal lesion biopsy; 56606 reports each additional distinct lesion and must accompany the primary code.
- 11104Punch biopsySingle skin lesion
- 11104 is for punch biopsy of a skin lesion in a different anatomic circumstance. Vulvar or perineal lesion biopsies are represented by the 56605/56606 code pair.
- 56620VulvectomySimple, partial excision
- 56620 describes a simple partial vulvectomy, which removes vulvar tissue rather than sampling an additional lesion for diagnosis.
56606 billing questions
When should 56606 be used instead of 56605?
Use 56605 for the primary lesion biopsy. Use 56606 for each additional distinct vulvar or perineal lesion biopsied during the service.
Can 56606 be reported by itself?
No. It is an add-on code and must be reported with the primary biopsy procedure, 56605.
What documentation supports an additional lesion?
Document the distinct lesion sites or describe how the sampled areas differ, along with the biopsy performed at each site.
How should units be determined?
Count additional distinct lesions biopsied beyond the primary lesion. Do not count multiple samples from one lesion as additional lesions.
Is a pathology examination included in 56606?
56606 describes the biopsy procedure. Histopathology of submitted tissue is a separate service when performed and reportable by the responsible pathology provider.
Does the add-on code have its own global period?
CMS pays 56606 within the primary procedure's global period; report it only with that primary procedure.
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
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