CPT code 57100: Vaginal biopsy, simple mucosal sampling2026 Medicare rate & RVUs

Medicare pays $105.21 for 57100 nationally in the office and $58.45 in a hospital or facility. Local office rates run $93.36–$132.09.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 57100 covers

A clinician, commonly a gynecologist, takes a limited sample of vaginal mucosa for diagnosis, often from a localized area that appears abnormal on examination. The procedure may be performed in an office or a facility. The tissue is submitted for microscopic evaluation; the biopsy service is distinct from the laboratory’s examination of the specimen when that service is performed.

Choose this code for a simple mucosal biopsy, rather than the more extensive biopsy described by 57105 or an excision such as removal of a vaginal cyst or tumor. Document the sampled site, the reason for biopsy, and the work performed. This minor procedure has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service; co-surgeons 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.

Where 57100 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

57100 rates by state

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

How the 57100 rate is calculated

Each of 57100’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.

Payment rules and modifiers for 57100

The CMS indicators that decide how 57100 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

57100 compared with similar codes

How to choose

57105Vaginal biopsyExtensive mucosal sampling

57100 represents simple vaginal mucosal sampling. 57105 is for an extensive biopsy, so the documented extent determines the choice.

57135Vaginal lesion excisionCyst or tumor

57135 describes excision of a vaginal cyst or tumor. Use 57100 when the service is a simple mucosal biopsy rather than removal of the lesion.

57421ColposcopyEntire vagina with biopsy

57421 is vaginal colposcopy with biopsy when performed. Do not add 57100 for a biopsy included in that colposcopy service.

Codes related to 57100

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

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

Open CMS sourceHow we calculate rates