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CPT code 57421: Colposcopy, entire vagina with biopsy2026 Medicare rate & RVUs in Puerto Rico

Report this service when colposcopic examination of the entire vagina, including the cervix if present, includes directed biopsy of vaginal or cervical tissue.

CMS RVU26DEffective Oct 1, 2026One payment locality2.3K Medicare services in 2024

In Puerto Rico, Medicare pays $182.88 for 57421 in the office and $109.27 when it’s performed in a hospital or facility.

$182.88Office (non-facility)
$109.27Hospital or facility
+0.5%vs the national office rate ($182.03)

Check a contract rate as a % of Medicare · 57421 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 57421 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 57421 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 57421 covers

A clinician uses a colposcope to inspect the entire vaginal canal and, when present, the cervix, then takes directed tissue samples from abnormal areas. Gynecologists commonly perform this in an office or outpatient facility when evaluating abnormal vaginal cytology, suspected vaginal intraepithelial lesions, or visible lesions requiring histologic assessment, including in patients who have had a hysterectomy.

Report the service when the examination covers the entire vagina and includes biopsy; the code accounts for the colposcopic examination and biopsy work. The record should identify the examined anatomy, the abnormal area sampled, and the clinical reason for sampling. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. For multiple procedures in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service, and 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 57421

Across 109 of 109 payment localities, the office rate for 57421 runs from $161.67 in Arkansas to $225.94 in San Benito County, CA. Puerto Rico pays $182.88. The RVUs are the same everywhere; the geographic indexes change the dollars.

57421 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$182.88
  2. Los Angeles, CA · California$197.87+$14.99
  3. Washington, DC area · District of Columbia$204.62+$21.74
  4. Miami, FL · Florida$207.43+$24.55
  5. Chicago, IL · Illinois$201.19+$18.31
  6. Manhattan, NY · New York$210.44+$27.56
  7. Alaska · Alaska$217.89+$35.01

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

Every other payment area

57421 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$163.92$100.21
ArkansasArkansas$161.67$99.12
ArizonaArizona$177.03$106.48
Bakersfield, CACalifornia$187.15$107.34
Chico, CACalifornia$185.98$106.18
El Centro, CACalifornia$186.05$106.25
Fresno, CACalifornia$185.98$106.18
Hanford, CACalifornia$185.98$106.18

57421 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.

$161.67

$217.89

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

View every state and territory as a table
57421 office rate range by state
State / territoryOffice rate rangeLocalities
AK$217.891
AL$163.921
AR$161.671
AZ$177.031
CA$185.98–$225.9429
CO$185.981
CT$193.821
DC$204.621
DE$179.821
FL$184.86–$207.433
GA$174.34–$186.612
GU$189.311
HI$189.311
IA$165.401
ID$166.951
IL$181.56–$201.194
IN$167.801
KS$165.841
KY$170.161
LA$170.38–$178.272
MA$185.43–$202.102
MD$182.76–$204.623
ME$169.04–$175.992
MI$175.48–$188.292
MN$174.951
MO$168.40–$177.453
MS$165.001
MT$182.011
NC$170.531
ND$173.701
NE$165.901
NH$184.231
NJ$195.12–$202.902
NM$176.871
NV$179.791
NY$173.06–$216.835
OH$173.781
OK$168.611
OR$177.48–$190.272
PA$173.38–$189.982
PR$182.881
RI$185.061
SC$172.621
SD$172.721
TN$166.791
TX$172.38–$187.218
UT$174.831
VA$176.28–$204.622
VI$182.881
VT$174.141
WA$184.71–$204.892
WI$168.291
WV$175.481
WY$178.391

See 57421 in every payment locality

How the 57421 rate is calculated

Each of 57421’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 · 57421

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.15

2.15 RVUs× 1.000 GPCI

Practice expense2.88

2.88 RVUs× 1.000 GPCI

Malpractice0.42

0.42 RVUs× 1.000 GPCI

Adjusted RVUs

5.4500

Conversion factor

$33.4009

Medicare rate

$182.03

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

6,487

Code
57421
Physician work
2.15
Practice expense
2.88
Malpractice
0.42

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 57421 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work2.15× 1.0002.1500
Practice expense2.88× 1.0112.9117
Malpractice0.42× 0.9850.4137
Total RVUs5.4754
Conversion factor× 33.4009

Office rate, Puerto Rico$182.88

Office: (2.15 × 1 + 2.88 × 1.011 + 0.42 × 0.985) × $33.4009 = $182.88

Facility: (2.15 × 1 + 0.7 × 1.011 + 0.42 × 0.985) × $33.4009 = $109.27

Open 57421 in the RVU calculator

Payment rules and modifiers for 57421

The CMS indicators that decide how 57421 is paid alongside other services.

CMS payment indicators · 57421

Colposcopy, entire vagina 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

57421 without 51 · national office

$182.03

Colposcopy, entire vagina with biopsy

57421-51 · Second procedure: 50%

$91.02

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 57421

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

Codes related to 57421
CodeHow it relatesOffice range, Puerto Rico
Same family
57420Vaginal colposcopy, without vaginal biopsyEntire-vagina colposcopy without the biopsy included in 57421.$138.29
Used instead
57452Colposcopy, cervix, no tissue samplingCervical colposcopy when examination is focused on the cervix and adjacent upper vagina.$126.21
57455Cervical biopsy, colposcopy-guided biopsyCervical colposcopy with biopsy when the entire-vagina examination is not performed.$161.74
57454Cervical colposcopy, biopsy and endocervical curettageCervical colposcopy with biopsy and endocervical curettage.$166.65

How 57421 has changed in Puerto Rico

57421 · Office / nonfacility

$182.88

Effective 2026-10-01

The base rate is $9.43 higher than on 2025-10-01, moving from $173.45 to $182.88 (5.4%).

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

    $173.45changed to$182.88

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.20 changed to 2.15
    • Practice expense RVU 2.76 changed to 2.88
    • Malpractice RVU 0.39 changed to 0.42
    • 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

    $179.51changed to$173.45

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 2.80 changed to 2.76
    • Malpractice RVU 0.38 changed to 0.39

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $176.58changed to$179.51

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $181.52changed to$176.58

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 2.78 changed to 2.80
    • Malpractice RVU 0.36 changed to 0.38
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $180.96changed to$181.52

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

  6. January 1, 2023

    RVU23A

    $184.00changed to$180.96

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 2.75 changed to 2.78
    • Malpractice RVU 0.35 changed to 0.36
    • 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

    $180.26changed to$184.00

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 2.61 changed to 2.75
    • Malpractice RVU 0.34 changed to 0.35

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $175.91changed to$180.26

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 2.31 changed to 2.61
    • Malpractice RVU 0.35 changed to 0.34
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $166.91changed to$175.91

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 2.09 changed to 2.31
    • Malpractice RVU 0.33 changed to 0.35
    • 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

    $161.65changed to$166.91

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.95 changed to 2.09

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $146.46changed to$161.65

    • Conversion factor 35.8887 changed to 35.9996
    • 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

    $131.31changed to$146.46

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.94 changed to 1.95
    • Malpractice RVU 0.34 changed to 0.33
    • 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

    $132.03changed to$131.31

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 1.95 changed to 1.94

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $131.38changed to$132.03

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $130.05changed to$131.38

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 1.93 changed to 1.95
    • Malpractice RVU 0.35 changed to 0.34
    • 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

    $126.66changed to$130.05

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 2.11 changed to 1.93
    • Malpractice RVU 0.37 changed to 0.35
    • 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: $126.66

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$182.88$109.27RVU26D
2026-07-01$182.88$109.27RVU26C
2026-04-01$182.88$109.27RVU26B
2026-01-01$182.88$109.27RVU26A
2025-10-01$173.45$118.73RVU25D
2025-07-01$173.45$118.73RVU25C
2025-04-01$173.45$118.73RVU25B
2025-01-01$173.45$118.73RVU25A
2024-10-01$179.51$121.52RVU24D
2024-07-01$179.51$121.52RVU24C
2024-04-01$179.51$121.52RVU24B
2024-03-09$179.51$121.52RVU24AR
2024-01-01$176.58$119.54RVU24A
2023-10-01$181.52$122.42RVU23D
2023-07-01$180.96$122.33RVU23C
2023-04-01$180.96$122.33RVU23B
2023-01-01$180.96$122.33RVU23A
2022-10-01$184.00$124.01RVU22D
2022-07-01$184.00$124.01RVU22C
2022-04-01$184.00$124.01RVU22B
2022-01-01$184.00$124.01RVU22A
2021-10-01$180.26$124.34RVU21D
2021-07-01$180.26$124.34RVU21C
2021-04-01$180.26$124.34RVU21B
2021-01-01$180.26$124.34RVU21A
2020-10-01$175.91$128.26RVU20D
2020-07-01$175.91$128.26RVU20C
2020-04-01$175.91$128.26RVU20B
2020-01-01$175.91$128.26RVU20A
2019-10-01$166.91$126.99RVU19D
2019-07-01$166.91$126.99RVU19C
2019-04-01$166.91$126.99RVU19B
2019-01-01$166.91$126.99RVU19A
2018-10-01$161.65$127.57RVU18D
2018-07-01$161.65$127.57RVU18C
2018-04-01$161.65$127.57RVU18B
2018-01-01$161.65$127.57RVU18AR1
2017-10-01$146.46$118.20RVU17D
2017-07-01$146.46$118.20RVU17C
2017-04-01$146.46$118.20RVU17B
2017-01-01$146.46$118.20RVU17A
2016-10-01$131.31$108.08RVU16D
2016-07-01$131.31$108.08RVU16C
2016-04-01$131.31$108.08RVU16B
2016-01-01$131.31$108.08RVU16A
2015-10-01$132.03$108.47RVU15D
2015-07-01$132.03$108.47RVU15C
2015-04-01$131.38$107.93RVU15B
2015-01-01$131.38$107.93RVU15A
2014-10-01$130.05$107.74RVU14D
2014-07-01$130.05$107.74RVU14C
2014-04-01$130.05$107.74RVU14B
2014-01-01$130.05$107.74RVU14A
2013-10-01$126.66$103.36RVU13D
2013-07-01$126.66$103.36RVU13C
2013-04-01$126.66$103.36RVU13B
2013-01-01$126.66$103.36RVU13AR

Price 57421 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

57421 billing questions

When should 57421 be selected instead of 57420?

Use 57421 when colposcopic examination of the entire vagina includes biopsy. Code 57420 describes the corresponding examination without biopsy.

Can the biopsy be reported separately from the colposcopy?

The biopsy is included in 57421 when performed as part of the colposcopic service. Document the sampled site and the reason for biopsy.

How does 57421 differ from 57455?

57421 covers examination of the entire vagina, with the cervix if present, and biopsy. 57455 is for cervical colposcopy with biopsy, rather than the entire-vagina examination.

Should modifier 50 be appended for biopsy on both sides?

No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this service.

Can an assistant or co-surgeon be billed with 57421?

Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.

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 57421PPRRVU2026_Oct_nonQPP.csv, line 6,487 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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