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CPT code 56606: Vulvar biopsy, each additional lesion2026 Medicare rate & RVUs in North Dakota

Reports biopsy sampling of each additional vulvar or perineal lesion after the primary lesion biopsy, such as when several distinct lesions require tissue diagnosis.

CMS RVU26DEffective Oct 1, 2026One payment locality5K Medicare services in 2024

In North Dakota, Medicare pays $37.29 for 56606 in the office and $23.60 when it’s performed in a hospital or facility.

$37.29Office (non-facility)
$23.60Hospital or facility
−4.6%vs the national office rate ($39.08)

Check a contract rate as a % of Medicare · 56606 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 56606 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in North Dakota
  2. What 56606 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 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.

How North Dakota compares for 56606

Across 109 of 109 payment localities, the office rate for 56606 runs from $35.08 in Arkansas to $47.92 in Alaska. North Dakota pays $37.29. The RVUs are the same everywhere; the geographic indexes change the dollars.

56606 in North Dakota vs other payment areas
  1. North Dakota · this page$37.29
  2. Los Angeles, CA · California$42.11+$4.82
  3. Washington, DC area · District of Columbia$43.60+$6.31
  4. Miami, FL · Florida$44.41+$7.12
  5. Chicago, IL · Illinois$43.19+$5.90
  6. Manhattan, NY · New York$44.92+$7.63
  7. Alaska · Alaska$47.92+$10.63

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

Every other payment area

56606 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$35.52$23.54
ArkansasArkansas$35.08$23.31
ArizonaArizona$38.09$24.82
Bakersfield, CACalifornia$39.98$24.97
Chico, CACalifornia$39.72$24.71
El Centro, CACalifornia$39.74$24.73
Fresno, CACalifornia$39.72$24.71
Hanford, CACalifornia$39.72$24.71

56606 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.

$35.08

$47.92

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

View every state and territory as a table
56606 office rate range by state
State / territoryOffice rate rangeLocalities
AK$47.921
AL$35.521
AR$35.081
AZ$38.091
CA$39.72–$47.6429
CO$39.791
CT$41.461
DC$43.601
DE$38.651
FL$39.80–$44.413
GA$37.71–$40.032
GU$40.281
HI$40.281
IA$35.731
ID$36.051
IL$39.20–$43.194
IN$36.221
KS$35.861
KY$36.821
LA$36.88–$38.422
MA$39.71–$42.992
MD$39.23–$43.603
ME$36.50–$37.812
MI$37.90–$40.512
MN$37.491
MO$36.51–$38.223
MS$35.791
MT$39.071
NC$36.791
ND$37.291
NE$35.821
NH$39.441
NJ$41.75–$43.312
NM$38.191
NV$38.601
NY$37.28–$46.225
OH$37.531
OK$36.481
OR$38.11–$40.602
PA$37.43–$40.722
PR$39.231
RI$39.691
SC$37.261
SD$37.081
TN$36.051
TX$37.24–$40.238
UT$37.691
VA$37.89–$43.602
VI$39.231
VT$37.411
WA$39.55–$43.532
WI$36.241
WV$38.011
WY$38.301

See 56606 in every payment locality

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

Office or facility?

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.

The exact North Dakota inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

6,411

Code
56606
Physician work
0.54
Practice expense
0.54
Malpractice
0.09

GPCI2026.csv

84

Locality
North Dakota
Physician work
1.000
Practice expense
1.000
Malpractice
0.406
Office calculation for 56606 in North Dakota
ComponentRVULocality factorAdjusted
Physician work0.54× 1.0000.5400
Practice expense0.54× 1.0000.5400
Malpractice0.09× 0.4060.0365
Total RVUs1.1165
Conversion factor× 33.4009

Office rate, North Dakota$37.29

Office: (0.54 × 1 + 0.54 × 1 + 0.09 × 0.406) × $33.4009 = $37.29

Facility: (0.54 × 1 + 0.13 × 1 + 0.09 × 0.406) × $33.4009 = $23.60

Open 56606 in the RVU calculator

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

RuleCMS valueWhat it means
Global periodZZZAdd-on code: falls within the primary procedure’s global period.
Multiple procedures0No multiple-procedure reduction.
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.

Codes related to 56606

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 56606
CodeHow it relatesOffice range, North Dakota
Primary code
56605Vulvar biopsy, first lesion sampledPrimary vulvar or perineal lesion biopsy that must accompany this additional-lesion code.$89.75
Often billed with
88305Tissue pathology exam, level IV specimenMay represent histopathologic examination of submitted biopsy tissue.$69.75
Used instead
11104Punch biopsy, single skin lesionPunch biopsy code for a skin lesion outside the vulva or perineum.$119.46

How 56606 has changed in North Dakota

56606 · Office / nonfacility

$37.29

Effective 2026-10-01

The base rate is $1.99 higher than on 2025-10-01, moving from $35.30 to $37.29 (5.6%).

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

    $35.30changed to$37.29

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 0.55 changed to 0.54
    • Practice expense RVU 0.50 changed to 0.54
    • Malpractice RVU 0.08 changed to 0.09
    • Malpractice GPCI 0.517 changed to 0.406

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $36.50changed to$35.30

    • Conversion factor 33.2875 changed to 32.3465
    • Malpractice RVU 0.09 changed to 0.08

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $35.90changed to$36.50

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $37.53changed to$35.90

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 0.51 changed to 0.50
    • Malpractice RVU 0.10 changed to 0.09
    • Malpractice GPCI 0.474 changed to 0.517

  5. January 1, 2023

    RVU23A

    $37.68changed to$37.53

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 0.50 changed to 0.51
    • Malpractice RVU 0.09 changed to 0.10
    • Malpractice GPCI 0.431 changed to 0.474

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $37.99changed to$37.68

    • Conversion factor 34.8931 changed to 34.6062

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $38.39changed to$37.99

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 0.47 changed to 0.50
    • Malpractice GPCI 0.485 changed to 0.431

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $37.96changed to$38.39

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 0.46 changed to 0.47
    • Malpractice RVU 0.08 changed to 0.09
    • Malpractice GPCI 0.540 changed to 0.485

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $37.55changed to$37.96

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 0.45 changed to 0.46

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $37.46changed to$37.55

    • Conversion factor 35.8887 changed to 35.9996
    • Malpractice GPCI 0.547 changed to 0.540

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $37.03changed to$37.46

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 0.44 changed to 0.45
    • Malpractice GPCI 0.554 changed to 0.547

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $37.33changed to$37.03

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 0.45 changed to 0.44
    • Malpractice RVU 0.07 changed to 0.08

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $37.14changed to$37.33

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $37.00changed to$37.14

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 0.44 changed to 0.45
    • Malpractice RVU 0.08 changed to 0.07
    • Malpractice GPCI 0.536 changed to 0.554

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $36.45changed to$37.00

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 0.48 changed to 0.44
    • Malpractice GPCI 0.517 changed to 0.536

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $36.45

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$37.29$23.60RVU26D
2026-07-01$37.29$23.60RVU26C
2026-04-01$37.29$23.60RVU26B
2026-01-01$37.29$23.60RVU26A
2025-10-01$35.30$26.57RVU25D
2025-07-01$35.30$26.57RVU25C
2025-04-01$35.30$26.57RVU25B
2025-01-01$35.30$26.57RVU25A
2024-10-01$36.50$27.51RVU24D
2024-07-01$36.50$27.51RVU24C
2024-04-01$36.50$27.51RVU24B
2024-03-09$36.50$27.51RVU24AR
2024-01-01$35.90$27.06RVU24A
2023-10-01$37.53$28.04RVU23D
2023-07-01$37.53$28.04RVU23C
2023-04-01$37.53$28.04RVU23B
2023-01-01$37.53$28.04RVU23A
2022-10-01$37.68$27.99RVU22D
2022-07-01$37.68$27.99RVU22C
2022-04-01$37.68$27.99RVU22B
2022-01-01$37.68$27.99RVU22A
2021-10-01$37.99$28.22RVU21D
2021-07-01$37.99$28.22RVU21C
2021-04-01$37.99$28.22RVU21B
2021-01-01$37.99$28.22RVU21A
2020-10-01$38.39$29.36RVU20D
2020-07-01$38.39$29.36RVU20C
2020-04-01$38.39$29.36RVU20B
2020-01-01$38.39$29.36RVU20A
2019-10-01$37.96$29.31RVU19D
2019-07-01$37.96$29.31RVU19C
2019-04-01$37.96$29.31RVU19B
2019-01-01$37.96$29.31RVU19A
2018-10-01$37.55$29.27RVU18D
2018-07-01$37.55$29.27RVU18C
2018-04-01$37.55$29.27RVU18B
2018-01-01$37.55$29.27RVU18AR1
2017-10-01$37.46$29.56RVU17D
2017-07-01$37.46$29.56RVU17C
2017-04-01$37.46$29.56RVU17B
2017-01-01$37.46$29.56RVU17A
2016-10-01$37.03$29.16RVU16D
2016-07-01$37.03$29.16RVU16C
2016-04-01$37.03$29.16RVU16B
2016-01-01$37.03$29.16RVU16A
2015-10-01$37.33$29.06RVU15D
2015-07-01$37.33$29.06RVU15C
2015-04-01$37.14$28.92RVU15B
2015-01-01$37.14$28.92RVU15A
2014-10-01$37.00$29.12RVU14D
2014-07-01$37.00$29.12RVU14C
2014-04-01$37.00$29.12RVU14B
2014-01-01$37.00$29.12RVU14A
2013-10-01$36.45$28.29RVU13D
2013-07-01$36.45$28.29RVU13C
2013-04-01$36.45$28.29RVU13B
2013-01-01$36.45$28.29RVU13AR

Price 56606 for an earlier date of service

Where the North Dakota rate applies

North Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 406 cities and communities in North Dakota. Some span more than one payment area; confirm with the service ZIP.

  • Abercrombie
  • Adams
  • Alamo
  • Alexander
  • Alice
  • Almont
  • Alsen
  • Ambrose

Browse all communities in North Dakota

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

Show the CMS file lines behind this rate
RVUs for 56606PPRRVU2026_Oct_nonQPP.csv, line 6,411 (RVU26D)
Geographic factors for North DakotaGPCI2026.csv, line 84 (RVU26D)

Open CMS sourceHow we calculate rates

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