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

Report this service for a simple biopsy of vaginal mucosa, such as sampling a localized abnormal area for diagnostic evaluation.

CMS RVU26DEffective Oct 1, 2026One payment locality4.6K Medicare services in 2024

In Puerto Rico, Medicare pays $105.75 for 57100 in the office and $58.47 when it’s performed in a hospital or facility.

$105.75Office (non-facility)
$58.47Hospital or facility
+0.5%vs the national office rate ($105.21)

Check a contract rate as a % of Medicare · 57100 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 57100 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 57100 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 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.

How Puerto Rico compares for 57100

Across 109 of 109 payment localities, the office rate for 57100 runs from $93.36 in Arkansas to $132.09 in San Benito County, CA. Puerto Rico pays $105.75. The RVUs are the same everywhere; the geographic indexes change the dollars.

57100 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$105.75
  2. Los Angeles, CA · California$115.10+$9.35
  3. Washington, DC area · District of Columbia$118.62+$12.87
  4. Miami, FL · Florida$118.86+$13.11
  5. Chicago, IL · Illinois$115.30+$9.55
  6. Manhattan, NY · New York$121.54+$15.79
  7. Alaska · Alaska$125.27+$19.52

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

Every other payment area

57100 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$94.68$53.76
ArkansasArkansas$93.36$53.19
ArizonaArizona$102.33$57.02
Bakersfield, CACalifornia$108.73$57.48
Chico, CACalifornia$108.11$56.86
El Centro, CACalifornia$108.15$56.90
Fresno, CACalifornia$108.11$56.86
Hanford, CACalifornia$108.11$56.86

57100 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.

$93.36

$125.27

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

View every state and territory as a table
57100 office rate range by state
State / territoryOffice rate rangeLocalities
AK$125.271
AL$94.681
AR$93.361
AZ$102.331
CA$108.11–$132.0929
CO$107.831
CT$112.061
DC$118.621
DE$103.961
FL$106.32–$118.863
GA$100.27–$107.752
GU$110.171
HI$110.171
IA$95.791
ID$96.641
IL$104.24–$115.304
IN$97.141
KS$95.921
KY$98.061
LA$98.14–$102.742
MA$107.46–$117.412
MD$105.71–$118.623
ME$97.73–$101.972
MI$101.05–$108.202
MN$101.741
MO$96.91–$102.413
MS$95.121
MT$105.201
NC$98.621
ND$100.851
NE$96.121
NH$106.701
NJ$112.90–$117.582
NM$101.811
NV$104.041
NY$100.09–$125.125
OH$100.161
OK$97.281
OR$102.80–$110.482
PA$99.99–$109.742
PR$105.751
RI$107.101
SC$99.641
SD$100.331
TN$96.461
TX$99.40–$107.888
UT$100.941
VA$102.05–$118.622
VI$105.751
VT$100.991
WA$107.08–$119.172
WI$97.661
WV$100.681
WY$103.301

See 57100 in every payment locality

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.

How the rate is built · 57100

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.17

1.17 RVUs× 1.000 GPCI

Practice expense1.76

1.76 RVUs× 1.000 GPCI

Malpractice0.22

0.22 RVUs× 1.000 GPCI

Adjusted RVUs

3.1500

Conversion factor

$33.4009

Medicare rate

$105.21

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

6,435

Code
57100
Physician work
1.17
Practice expense
1.76
Malpractice
0.22

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 57100 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work1.17× 1.0001.1700
Practice expense1.76× 1.0111.7794
Malpractice0.22× 0.9850.2167
Total RVUs3.1661
Conversion factor× 33.4009

Office rate, Puerto Rico$105.75

Office: (1.17 × 1 + 1.76 × 1.011 + 0.22 × 0.985) × $33.4009 = $105.75

Facility: (1.17 × 1 + 0.36 × 1.011 + 0.22 × 0.985) × $33.4009 = $58.47

Open 57100 in the RVU calculator

Payment rules and modifiers for 57100

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

CMS payment indicators · 57100

Vaginal biopsy, simple mucosal sampling

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

57100 without 51 · national office

$105.21

Vaginal biopsy, simple mucosal sampling

57100-51 · Second procedure: 50%

$52.61

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 57100

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

Codes related to 57100
CodeHow it relatesOffice range, Puerto Rico
Same family
57105Vaginal biopsy, extensive mucosal samplingMore extensive vaginal mucosal biopsy; select according to the extent of biopsy documented.$176.37
Used instead
57135Vaginal lesion excision, cyst or tumorExcision of a vaginal cyst or tumor, rather than simple mucosal sampling.$244.47
Often billed with
88305Tissue pathology exam, level IV specimenMay represent microscopic examination of the vaginal biopsy specimen by the pathology service.$70.63
57421Colposcopy, entire vagina with biopsyVaginal colposcopy service that includes biopsy when performed; do not separately bill the same biopsy.$182.88

How 57100 has changed in Puerto Rico

57100 · Office / nonfacility

$105.75

Effective 2026-10-01

The base rate is $5.21 higher than on 2025-10-01, moving from $100.54 to $105.75 (5.2%).

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

    $100.54changed to$105.75

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.20 changed to 1.17
    • Practice expense RVU 1.70 changed to 1.76
    • Malpractice RVU 0.20 changed to 0.22
    • 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

    $104.47changed to$100.54

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 1.73 changed to 1.70

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $102.77changed to$104.47

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $105.75changed to$102.77

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 1.72 changed to 1.73
    • Malpractice RVU 0.19 changed to 0.20
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $105.39changed to$105.75

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

  6. January 1, 2023

    RVU23A

    $107.65changed to$105.39

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 1.70 changed to 1.72
    • Malpractice RVU 0.20 changed to 0.19
    • 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

    $104.68changed to$107.65

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 1.60 changed to 1.70
    • Malpractice RVU 0.19 changed to 0.20

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $99.93changed to$104.68

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.38 changed to 1.60
    • Malpractice RVU 0.18 changed to 0.19
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $95.39changed to$99.93

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.25 changed to 1.38
    • Malpractice RVU 0.19 changed to 0.18
    • 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

    $91.66changed to$95.39

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.15 changed to 1.25

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $83.08changed to$91.66

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.16 changed to 1.15
    • 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

    $73.88changed to$83.08

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.15 changed to 1.16
    • Malpractice RVU 0.18 changed to 0.19
    • 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

    $74.25changed to$73.88

    • Conversion factor 35.9335 changed to 35.8043
    • Malpractice RVU 0.19 changed to 0.18

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $73.88changed to$74.25

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $73.09changed to$73.88

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 1.14 changed to 1.15
    • 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

    $71.13changed to$73.09

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 1.24 changed to 1.14
    • Malpractice RVU 0.20 changed to 0.19
    • 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: $71.13

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$105.75$58.47RVU26D
2026-07-01$105.75$58.47RVU26C
2026-04-01$105.75$58.47RVU26B
2026-01-01$105.75$58.47RVU26A
2025-10-01$100.54$63.74RVU25D
2025-07-01$100.54$63.74RVU25C
2025-04-01$100.54$63.74RVU25B
2025-01-01$100.54$63.74RVU25A
2024-10-01$104.47$65.25RVU24D
2024-07-01$104.47$65.25RVU24C
2024-04-01$104.47$65.25RVU24B
2024-03-09$104.47$65.25RVU24AR
2024-01-01$102.77$64.19RVU24A
2023-10-01$105.75$65.79RVU23D
2023-07-01$105.39$65.74RVU23C
2023-04-01$105.39$65.74RVU23B
2023-01-01$105.39$65.74RVU23A
2022-10-01$107.65$67.19RVU22D
2022-07-01$107.65$67.19RVU22C
2022-04-01$107.65$67.19RVU22B
2022-01-01$107.65$67.19RVU22A
2021-10-01$104.68$67.40RVU21D
2021-07-01$104.68$67.40RVU21C
2021-04-01$104.68$67.40RVU21B
2021-01-01$104.68$67.40RVU21A
2020-10-01$99.93$68.64RVU20D
2020-07-01$99.93$68.64RVU20C
2020-04-01$99.93$68.64RVU20B
2020-01-01$99.93$68.64RVU20A
2019-10-01$95.39$68.90RVU19D
2019-07-01$95.39$68.90RVU19C
2019-04-01$95.39$68.90RVU19B
2019-01-01$95.39$68.90RVU19A
2018-10-01$91.66$69.18RVU18D
2018-07-01$91.66$69.18RVU18C
2018-04-01$91.66$69.18RVU18B
2018-01-01$91.66$69.18RVU18AR1
2017-10-01$83.08$64.03RVU17D
2017-07-01$83.08$64.03RVU17C
2017-04-01$83.08$64.03RVU17B
2017-01-01$83.08$64.03RVU17A
2016-10-01$73.88$58.23RVU16D
2016-07-01$73.88$58.23RVU16C
2016-04-01$73.88$58.23RVU16B
2016-01-01$73.88$58.23RVU16A
2015-10-01$74.25$58.55RVU15D
2015-07-01$74.25$58.55RVU15C
2015-04-01$73.88$58.26RVU15B
2015-01-01$73.88$58.26RVU15A
2014-10-01$73.09$57.97RVU14D
2014-07-01$73.09$57.97RVU14C
2014-04-01$73.09$57.97RVU14B
2014-01-01$73.09$57.97RVU14A
2013-10-01$71.13$55.67RVU13D
2013-07-01$71.13$55.67RVU13C
2013-04-01$71.13$55.67RVU13B
2013-01-01$71.13$55.67RVU13AR

Price 57100 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

57100 billing questions

When should 57100 be chosen instead of 57105?

Use 57100 for a simple, limited vaginal mucosal biopsy. Use 57105 when the documented biopsy is extensive.

Can the pathology examination be reported separately?

The biopsy is the tissue-sampling service. When a laboratory performs microscopic examination of the specimen, that pathology service may be reported separately, such as with 88305 when the specimen and service meet that code’s criteria.

Can 57100 be reported with vaginal colposcopy code 57421?

Code 57421 includes vaginal or cervical biopsy when performed as part of the colposcopy service. Do not separately report 57100 for that same biopsy.

Is modifier 50 appropriate for biopsies from both sides of the vagina?

No. CMS identifies bilateral adjustment as inappropriate for 57100; modifier 50 should not be used.

What documentation supports 57100?

Record the vaginal site sampled, the clinical reason for sampling, and that a simple mucosal biopsy was performed. The operative or procedure note should distinguish sampling from a more extensive biopsy or excision.

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 57100PPRRVU2026_Oct_nonQPP.csv, line 6,435 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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