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CPT code 56821: Vulvar colposcopy, with biopsy2026 Medicare rate & RVUs in Puerto Rico

Reports magnified examination of vulvar tissue with targeted biopsy when evaluating suspicious lesions or abnormal vulvar findings.

CMS RVU26DEffective Oct 1, 2026One payment locality2K Medicare services in 2024

In Puerto Rico, Medicare pays $171.83 for 56821 in the office and $101.25 when it’s performed in a hospital or facility.

$171.83Office (non-facility)
$101.25Hospital or facility
+0.5%vs the national office rate ($171.01)

Check a contract rate as a % of Medicare · 56821 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 56821 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 56821 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 56821 covers

Vulvar colposcopy with biopsy uses magnification and directed inspection of the vulvar surface, often after application of acetic acid, to identify abnormal epithelium and obtain tissue. Gynecologists commonly perform it in an office or outpatient setting when lesions or abnormal vulvar findings require histologic evaluation, including concern for vulvar intraepithelial neoplasia. The sampled tissue is sent for pathology; the code represents the examination and biopsy in the same service.

Report 56821 when the colposcopic vulvar examination includes one or more directed biopsies; use 56820 when the examination has no biopsy. Record the indication, vulvar site and appearance, colposcopic findings, biopsy locations, and specimen submission. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in one session, the highest-valued procedure is paid in full and others are paid at 50%. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service; co-surgery and team surgery are not permitted.

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 56821

Across 109 of 109 payment localities, the office rate for 56821 runs from $151.95 in Arkansas to $212.92 in San Benito County, CA. Puerto Rico pays $171.83. The RVUs are the same everywhere; the geographic indexes change the dollars.

56821 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$171.83
  2. Los Angeles, CA · California$186.23+$14.40
  3. Washington, DC area · District of Columbia$192.34+$20.51
  4. Miami, FL · Florida$194.17+$22.34
  5. Chicago, IL · Illinois$188.37+$16.54
  6. Manhattan, NY · New York$197.55+$25.72
  7. Alaska · Alaska$204.66+$32.83

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

Every other payment area

56821 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$154.06$92.98
ArkansasArkansas$151.95$91.99
ArizonaArizona$166.35$98.70
Bakersfield, CACalifornia$176.10$99.60
Chico, CACalifornia$175.04$98.54
El Centro, CACalifornia$175.11$98.60
Fresno, CACalifornia$175.04$98.54
Hanford, CACalifornia$175.04$98.54

56821 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.

$151.95

$204.66

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

View every state and territory as a table
56821 office rate range by state
State / territoryOffice rate rangeLocalities
AK$204.661
AL$154.061
AR$151.951
AZ$166.351
CA$175.04–$212.9229
CO$174.891
CT$182.061
DC$192.341
DE$168.971
FL$173.37–$194.173
GA$163.57–$175.232
GU$178.211
HI$178.211
IA$155.581
ID$157.001
IL$170.20–$188.374
IN$157.811
KS$155.931
KY$159.781
LA$159.95–$167.342
MA$174.36–$190.112
MD$171.74–$192.343
ME$158.89–$165.512
MI$164.69–$176.522
MN$164.731
MO$158.05–$166.653
MS$154.981
MT$170.991
NC$160.301
ND$163.471
NE$156.071
NH$173.181
NJ$183.34–$190.732
NM$165.971
NV$168.981
NY$162.67–$203.465
OH$163.151
OK$158.391
OR$166.88–$178.992
PA$162.81–$178.422
PR$171.831
RI$173.931
SC$162.151
SD$162.581
TN$156.811
TX$161.87–$175.688
UT$164.231
VA$165.73–$192.342
VI$171.831
VT$163.831
WA$173.70–$192.802
WI$158.391
WV$164.491
WY$167.711

See 56821 in every payment locality

How the 56821 rate is calculated

Each of 56821’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 · 56821

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.00

2.00 RVUs× 1.000 GPCI

Practice expense2.74

2.74 RVUs× 1.000 GPCI

Malpractice0.38

0.38 RVUs× 1.000 GPCI

Adjusted RVUs

5.1200

Conversion factor

$33.4009

Medicare rate

$171.01

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

6,427

Code
56821
Physician work
2.00
Practice expense
2.74
Malpractice
0.38

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 56821 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work2.00× 1.0002.0000
Practice expense2.74× 1.0112.7701
Malpractice0.38× 0.9850.3743
Total RVUs5.1444
Conversion factor× 33.4009

Office rate, Puerto Rico$171.83

Office: (2 × 1 + 2.74 × 1.011 + 0.38 × 0.985) × $33.4009 = $171.83

Facility: (2 × 1 + 0.65 × 1.011 + 0.38 × 0.985) × $33.4009 = $101.25

Open 56821 in the RVU calculator

Payment rules and modifiers for 56821

The CMS indicators that decide how 56821 is paid alongside other services.

CMS payment indicators · 56821

Vulvar colposcopy, with biopsy

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)0Not permitted.
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

56821 without 51 · national office

$171.01

Vulvar colposcopy, with biopsy

56821-51 · Second procedure: 50%

$85.51

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

Codes related to 56821

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

Codes related to 56821
CodeHow it relatesOffice range, Puerto Rico
Same family
56820Vulvar colposcopy, without biopsyVulvar colposcopy without biopsy; distinguishes examination-only service from 56821.$128.56
Used instead
56605Vulvar biopsy, first lesion sampledVulvar or perineal biopsy when the service is biopsy without vulvar colposcopy.$93.99
57455Cervical biopsy, colposcopy-guided biopsyColposcopic biopsy service for the cervix rather than the vulva.$161.74

How 56821 has changed in Puerto Rico

56821 · Office / nonfacility

$171.83

Effective 2026-10-01

The base rate is $8.41 higher than on 2025-10-01, moving from $163.42 to $171.83 (5.1%).

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

    $163.42changed to$171.83

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.05 changed to 2.00
    • Practice expense RVU 2.64 changed to 2.74
    • Malpractice RVU 0.35 changed to 0.38
    • 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

    $169.52changed to$163.42

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 2.68 changed to 2.64

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $166.75changed to$169.52

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $171.66changed to$166.75

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 2.65 changed to 2.68
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $171.13changed to$171.66

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $173.94changed to$171.13

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 2.62 changed to 2.65
    • Malpractice RVU 0.34 changed to 0.35
    • 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

    $170.12changed to$173.94

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 2.49 changed to 2.62
    • Malpractice RVU 0.32 changed to 0.34

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $165.43changed to$170.12

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 2.20 changed to 2.49
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $157.53changed to$165.43

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 2.01 changed to 2.20
    • Malpractice RVU 0.30 changed to 0.32
    • 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

    $151.56changed to$157.53

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.86 changed to 2.01
    • Malpractice RVU 0.29 changed to 0.30

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $137.62changed to$151.56

    • Conversion factor 35.8887 changed to 35.9996
    • Malpractice RVU 0.30 changed to 0.29
    • 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

    $123.24changed to$137.62

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.85 changed to 1.86
    • 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

    $123.79changed to$123.24

    • Conversion factor 35.9335 changed to 35.8043
    • Malpractice RVU 0.31 changed to 0.30

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $123.18changed to$123.79

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $122.25changed to$123.18

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 1.84 changed to 1.85
    • Malpractice RVU 0.33 changed to 0.31
    • 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

    $118.99changed to$122.25

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 2.01 changed to 1.84
    • Malpractice RVU 0.34 changed to 0.33
    • 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: $118.99

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$171.83$101.25RVU26D
2026-07-01$171.83$101.25RVU26C
2026-04-01$171.83$101.25RVU26B
2026-01-01$171.83$101.25RVU26A
2025-10-01$163.42$110.33RVU25D
2025-07-01$163.42$110.33RVU25C
2025-04-01$163.42$110.33RVU25B
2025-01-01$163.42$110.33RVU25A
2024-10-01$169.52$113.20RVU24D
2024-07-01$169.52$113.20RVU24C
2024-04-01$169.52$113.20RVU24B
2024-03-09$169.52$113.20RVU24AR
2024-01-01$166.75$111.35RVU24A
2023-10-01$171.66$114.61RVU23D
2023-07-01$171.13$114.54RVU23C
2023-04-01$171.13$114.54RVU23B
2023-01-01$171.13$114.54RVU23A
2022-10-01$173.94$116.03RVU22D
2022-07-01$173.94$116.03RVU22C
2022-04-01$173.94$116.03RVU22B
2022-01-01$173.94$116.03RVU22A
2021-10-01$170.12$115.95RVU21D
2021-07-01$170.12$115.95RVU21C
2021-04-01$170.12$115.95RVU21B
2021-01-01$170.12$115.95RVU21A
2020-10-01$165.43$119.23RVU20D
2020-07-01$165.43$119.23RVU20C
2020-04-01$165.43$119.23RVU20B
2020-01-01$165.43$119.23RVU20A
2019-10-01$157.53$118.33RVU19D
2019-07-01$157.53$118.33RVU19C
2019-04-01$157.53$118.33RVU19B
2019-01-01$157.53$118.33RVU19A
2018-10-01$151.56$118.57RVU18D
2018-07-01$151.56$118.57RVU18C
2018-04-01$151.56$118.57RVU18B
2018-01-01$151.56$118.57RVU18AR1
2017-10-01$137.62$110.28RVU17D
2017-07-01$137.62$110.28RVU17C
2017-04-01$137.62$110.28RVU17B
2017-01-01$137.62$110.28RVU17A
2016-10-01$123.24$100.53RVU16D
2016-07-01$123.24$100.53RVU16C
2016-04-01$123.24$100.53RVU16B
2016-01-01$123.24$100.53RVU16A
2015-10-01$123.79$100.99RVU15D
2015-07-01$123.79$100.99RVU15C
2015-04-01$123.18$100.49RVU15B
2015-01-01$123.18$100.49RVU15A
2014-10-01$122.25$100.44RVU14D
2014-07-01$122.25$100.44RVU14C
2014-04-01$122.25$100.44RVU14B
2014-01-01$122.25$100.44RVU14A
2013-10-01$118.99$96.39RVU13D
2013-07-01$118.99$96.39RVU13C
2013-04-01$118.99$96.39RVU13B
2013-01-01$118.99$96.39RVU13AR

Price 56821 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

56821 billing questions

When should 56821 be chosen over 56820?

Use 56821 when the vulvar colposcopic examination includes a directed biopsy. Use 56820 for the examination without biopsy.

Is the biopsy separately reportable?

The biopsy is included in 56821 when performed as part of the vulvar colposcopic service. Do not separately report a vulvar biopsy code for that same biopsy.

Should modifier 50 be appended?

No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 is not appropriate.

How does CMS handle other procedures performed in the same session?

The highest-valued procedure is paid in full, and other procedures in the session are paid at 50% under the standard multiple-procedure reduction.

What documentation supports reporting 56821?

Document the reason for examination, vulvar findings and biopsy site or sites, and that tissue was obtained and submitted for pathology.

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 56821PPRRVU2026_Oct_nonQPP.csv, line 6,427 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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