CPT code 69100: Ear biopsy, auricle, not ear canal2026 Medicare rate & RVUs in Manhattan, NY

Reports tissue sampling of a lesion on the visible external ear, such as the pinna, for histologic diagnosis rather than ear-canal biopsy.

CMS RVU26DEffective Oct 1, 2026One payment locality170.2K Medicare services in 2024

In Manhattan, NY, Medicare pays $105.91 for 69100 in the office and $41.87 when it’s performed in a hospital or facility.

$105.91Office (non-facility)
$41.87Hospital or facility
+14.5%vs the national office rate ($92.52)

Check a contract rate as a % of Medicare · 69100 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 69100 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Manhattan, NY
  2. What 69100 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 69100 covers

This service obtains tissue from the visible external ear, such as the auricle or pinna, when a lesion requires histologic diagnosis. Otolaryngologists and dermatologists commonly perform it in an office or procedure room. The sampled structure distinguishes this code from a biopsy of the external auditory canal: a lesion on the pinna is the relevant site, not a lesion deeper in the canal.

Choose the code according to the biopsy site and service performed. Document the exact ear subsite, lesion, reason for sampling, and procedure performed. A 0-day global period includes same-day preoperative and postoperative care. 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% reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, 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 Manhattan, NY compares for 69100

Across 109 of 109 payment localities, the office rate for 69100 runs from $82.39 in Arkansas to $122.54 in San Benito County, CA. Manhattan, NY pays $105.91. The RVUs are the same everywhere; the geographic indexes change the dollars.

69100 in Manhattan, NY vs other payment areas
  1. Manhattan, NY · this page$105.91
  2. NYC suburbs and Long Island, NY · New York$108.27+$2.36
  3. Queens, NY · New York$106.85+$0.94
  4. Rest of New York · New York$88.64−$17.27
  5. Los Angeles, CA · California$104.49−$1.42
  6. Washington, DC area · District of Columbia$105.57−$0.34

Other areas in New York first, then benchmark localities. Bars start at $0.

Every other payment area

69100 in every other Medicare payment locality
Payment localityOfficeFacility
Miami, FLFlorida$98.71$41.34
Chicago, ILIllinois$96.05$40.66
AlaskaAlaska$108.81$50.12
AlabamaAlabama$83.53$35.31
ArkansasArkansas$82.39$35.05
ArizonaArizona$90.21$36.80
Bakersfield, CACalifornia$98.23$37.83
Chico, CACalifornia$98.01$37.61

69100 rates by state

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

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$82.39

$110.28

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

View every state and territory as a table
69100 office rate range by state
State / territoryOffice rate rangeLocalities
AK$108.811
AL$83.531
AR$82.391
AZ$90.211
CA$98.01–$122.5429
CO$96.411
CT$98.451
DC$105.571
DE$91.651
FL$90.89–$98.713
GA$86.08–$94.092
GU$100.281
HI$100.281
IA$85.691
ID$86.181
IL$88.29–$96.234
IN$86.661
KS$85.241
KY$85.241
LA$85.09–$89.072
MA$95.85–$105.722
MD$93.36–$105.573
ME$86.53–$91.082
MI$87.27–$91.892
MN$92.721
MO$83.66–$89.463
MS$83.041
MT$92.521
NC$87.401
ND$91.131
NE$86.151
NH$94.841
NJ$99.67–$104.552
NM$87.701
NV$92.191
NY$88.64–$108.275
OH$86.991
OK$85.171
OR$91.57–$99.432
PA$87.16–$96.062
PR$93.191
RI$94.871
SC$87.321
SD$90.971
TN$85.631
TX$86.61–$96.018
UT$88.451
VA$90.75–$105.572
VI$93.191
VT$90.731
WA$95.69–$107.892
WI$88.221
WV$85.171
WY$91.911

See 69100 in every payment locality

How the 69100 rate is calculated

Each of 69100’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 · 69100

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.79

0.79 RVUs× 1.000 GPCI

Practice expense1.91

1.91 RVUs× 1.000 GPCI

Malpractice0.07

0.07 RVUs× 1.000 GPCI

Adjusted RVUs

2.7700

Conversion factor

$33.4009

Medicare rate

$92.52

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Manhattan, NY inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

7,584

Code
69100
Physician work
0.79
Practice expense
1.91
Malpractice
0.07

GPCI2026.csv

78

Locality
Manhattan, NY
Physician work
1.064
Practice expense
1.162
Malpractice
1.586
Office calculation for 69100 in Manhattan, NY
ComponentRVULocality factorAdjusted
Physician work0.79× 1.0640.8406
Practice expense1.91× 1.1622.2194
Malpractice0.07× 1.5860.1110
Total RVUs3.1710
Conversion factor× 33.4009

Office rate, Manhattan, NY$105.91

Office: (0.79 × 1.064 + 1.91 × 1.162 + 0.07 × 1.586) × $33.4009 = $105.91

Facility: (0.79 × 1.064 + 0.26 × 1.162 + 0.07 × 1.586) × $33.4009 = $41.87

Open 69100 in the RVU calculator

Payment rules and modifiers for 69100

The CMS indicators that decide how 69100 is paid alongside other services.

CMS payment indicators · 69100

Ear biopsy, auricle, not ear canal

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

69100 without 51 · national office

$92.52

Ear biopsy, auricle, not ear canal

69100-51 · Second procedure: 50%

$46.26

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

How 69100 has changed in Manhattan, NY

69100 · Office / nonfacility

$105.91

Effective 2026-10-01

The base rate is $0.55 higher than on 2025-10-01, moving from $105.36 to $105.91 (0.5%).

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

    $105.36changed to$105.91

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 0.81 changed to 0.79
    • Practice expense RVU 1.94 changed to 1.91
    • Malpractice RVU 0.08 changed to 0.07
    • Work GPCI 1.065 changed to 1.064
    • Practice expense GPCI 1.166 changed to 1.162
    • Malpractice GPCI 1.656 changed to 1.586

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $110.14changed to$105.36

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 1.97 changed to 1.94
    • Malpractice RVU 0.09 changed to 0.08

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $108.34changed to$110.14

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $115.21changed to$108.34

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 1.99 changed to 1.97
    • Malpractice RVU 0.10 changed to 0.09
    • Work GPCI 1.061 changed to 1.065
    • Practice expense GPCI 1.184 changed to 1.166
    • Malpractice GPCI 1.843 changed to 1.656
  5. January 1, 2023

    RVU23A

    $118.36changed to$115.21

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 1.98 changed to 1.99
    • Malpractice RVU 0.09 changed to 0.10
    • Work GPCI 1.056 changed to 1.061
    • Practice expense GPCI 1.203 changed to 1.184
    • Malpractice GPCI 2.031 changed to 1.843

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $120.60changed to$118.36

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 2.01 changed to 1.98

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $118.04changed to$120.60

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.89 changed to 2.01
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.192 changed to 1.203
    • Malpractice GPCI 1.823 changed to 2.031

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $116.64changed to$118.04

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.87 changed to 1.89
    • Malpractice RVU 0.11 changed to 0.09
    • Work GPCI 1.052 changed to 1.054
    • Practice expense GPCI 1.180 changed to 1.192
    • Malpractice GPCI 1.615 changed to 1.823

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $119.91changed to$116.64

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.95 changed to 1.87

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $118.99changed to$119.91

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.94 changed to 1.95
    • Practice expense GPCI 1.174 changed to 1.180
    • Malpractice GPCI 1.690 changed to 1.615

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $118.17changed to$118.99

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.93 changed to 1.94
    • Practice expense GPCI 1.168 changed to 1.174
    • Malpractice GPCI 1.764 changed to 1.690

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $118.38changed to$118.17

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 1.94 changed to 1.93
    • Malpractice RVU 0.10 changed to 0.11

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $117.79changed to$118.38

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $114.69changed to$117.79

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 1.87 changed to 1.94
    • Malpractice RVU 0.11 changed to 0.10
    • Work GPCI 1.057 changed to 1.052
    • Practice expense GPCI 1.165 changed to 1.168
    • Malpractice GPCI 1.518 changed to 1.764

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $118.23changed to$114.69

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 2.13 changed to 1.87
    • Work GPCI 1.062 changed to 1.057
    • Practice expense GPCI 1.162 changed to 1.165
    • Malpractice GPCI 1.271 changed to 1.518

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $118.23

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$105.91$41.87RVU26D
2026-07-01$105.91$41.87RVU26C
2026-04-01$105.91$41.87RVU26B
2026-01-01$105.91$41.87RVU26A
2025-10-01$105.36$50.67RVU25D
2025-07-01$105.36$50.67RVU25C
2025-04-01$105.36$50.67RVU25B
2025-01-01$105.36$50.67RVU25A
2024-10-01$110.14$52.31RVU24D
2024-07-01$110.14$52.31RVU24C
2024-04-01$110.14$52.31RVU24B
2024-03-09$110.14$52.31RVU24AR
2024-01-01$108.34$51.45RVU24A
2023-10-01$115.21$54.63RVU23D
2023-07-01$115.21$54.63RVU23C
2023-04-01$115.21$54.63RVU23B
2023-01-01$115.21$54.63RVU23A
2022-10-01$118.36$55.08RVU22D
2022-07-01$118.36$55.08RVU22C
2022-04-01$118.36$55.08RVU22B
2022-01-01$118.36$55.08RVU22A
2021-10-01$120.60$55.53RVU21D
2021-07-01$120.60$55.53RVU21C
2021-04-01$120.60$55.53RVU21B
2021-01-01$120.60$55.53RVU21A
2020-10-01$118.04$56.95RVU20D
2020-07-01$118.04$56.95RVU20C
2020-04-01$118.04$56.95RVU20B
2020-01-01$118.04$56.95RVU20A
2019-10-01$116.64$57.52RVU19D
2019-07-01$116.64$57.52RVU19C
2019-04-01$116.64$57.52RVU19B
2019-01-01$116.64$57.52RVU19A
2018-10-01$119.91$57.89RVU18D
2018-07-01$119.91$57.89RVU18C
2018-04-01$119.91$57.89RVU18B
2018-01-01$119.91$57.89RVU18AR1
2017-10-01$118.99$57.90RVU17D
2017-07-01$118.99$57.90RVU17C
2017-04-01$118.99$57.90RVU17B
2017-01-01$118.99$57.90RVU17A
2016-10-01$118.17$57.95RVU16D
2016-07-01$118.17$57.95RVU16C
2016-04-01$118.17$57.95RVU16B
2016-01-01$118.17$57.95RVU16A
2015-10-01$118.38$57.52RVU15D
2015-07-01$118.38$57.52RVU15C
2015-04-01$117.79$57.24RVU15B
2015-01-01$117.79$57.24RVU15A
2014-10-01$114.69$56.68RVU14D
2014-07-01$114.69$56.68RVU14C
2014-04-01$114.69$56.68RVU14B
2014-01-01$114.69$56.68RVU14A
2013-10-01$118.23$54.98RVU13D
2013-07-01$118.23$54.98RVU13C
2013-04-01$118.23$54.98RVU13B
2013-01-01$118.23$54.98RVU13AR

Price 69100 for an earlier date of service

Where the Manhattan, NY rate applies

Manhattan, NY is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in New York. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in New York

69100 billing questions

How is this different from 69105?

69100 is for tissue sampled from the visible external ear, such as the pinna. Use 69105 when the biopsy site is in the external auditory canal.

Can the pathology examination be billed separately?

The biopsy code represents tissue acquisition. A separately performed pathology examination may be reported by the responsible laboratory.

Should modifier 50 be used when both ears are biopsied?

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

What happens when another procedure is performed in the same session?

The highest-valued procedure is paid in full; other procedures are subject to the standard multiple-procedure reduction. Same-day preoperative and postoperative care is included in the 0-day global period.

What documentation supports reporting this code?

Record the lesion, the precise external-ear site sampled, the reason for tissue diagnosis, and the biopsy performed. The documented site should distinguish the auricle or pinna from the ear canal.

Can an assistant surgeon or co-surgeon be reported?

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 69100PPRRVU2026_Oct_nonQPP.csv, line 7,584 (RVU26D)
Geographic factors for Manhattan, NYGPCI2026.csv, line 78 (RVU26D)

Open CMS sourceHow we calculate rates

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