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

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 Puerto Rico, Medicare pays $93.19 for 69100 in the office and $37.47 when it’s performed in a hospital or facility.

$93.19Office (non-facility)
$37.47Hospital or facility
+0.7%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 Puerto Rico
  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 Puerto Rico 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. Puerto Rico pays $93.19. The RVUs are the same everywhere; the geographic indexes change the dollars.

69100 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$93.19
  2. Los Angeles, CA · California$104.49+$11.30
  3. Washington, DC area · District of Columbia$105.57+$12.38
  4. Miami, FL · Florida$98.71+$5.52
  5. Chicago, IL · Illinois$96.05+$2.86
  6. Manhattan, NY · New York$105.91+$12.72
  7. Alaska · Alaska$108.81+$15.62

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

Every other payment area

69100 in every other Medicare payment locality
Payment localityOfficeFacility
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
El Centro, CACalifornia$98.02$37.62
Fresno, CACalifornia$98.01$37.61
Hanford, CACalifornia$98.01$37.61

69100 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.

$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 Puerto Rico 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

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 69100 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work0.79× 1.0000.7900
Practice expense1.91× 1.0111.9310
Malpractice0.07× 0.9850.0690
Total RVUs2.7900
Conversion factor× 33.4009

Office rate, Puerto Rico$93.19

Office: (0.79 × 1 + 1.91 × 1.011 + 0.07 × 0.985) × $33.4009 = $93.19

Facility: (0.79 × 1 + 0.26 × 1.011 + 0.07 × 0.985) × $33.4009 = $37.47

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

Codes related to 69100

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

Codes related to 69100
CodeHow it relatesOffice range, Puerto Rico
Used instead
69105Ear canal biopsy, external auditory canalBiopsy of a lesion in the external auditory canal rather than the visible external ear.$145.14
69110Auricular excision, partial auricleFor partial removal of external-ear tissue when removal, rather than diagnostic sampling, is performed.$472.75
Often billed with
88305Tissue pathology exam, level IV specimenA laboratory may report a separately performed surgical pathology examination of submitted biopsy tissue.$70.63

How 69100 has changed in Puerto Rico

69100 · Office / nonfacility

$93.19

Effective 2026-10-01

The base rate is $1.26 higher than on 2025-10-01, moving from $91.93 to $93.19 (1.4%).

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

    $91.93changed to$93.19

    • 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
    • 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

    $95.94changed to$91.93

    • 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

    $94.37changed to$95.94

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $98.76changed to$94.37

    • 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
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $98.27changed to$98.76

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

  6. January 1, 2023

    RVU23A

    $100.17changed to$98.27

    • 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
    • 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

    $102.06changed to$100.17

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

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $101.20changed to$102.06

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.89 changed to 2.01
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $100.98changed to$101.20

    • 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
    • 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

    $103.77changed to$100.98

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

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $91.20changed to$103.77

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.94 changed to 1.95
    • 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

    $78.87changed to$91.20

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.93 changed to 1.94
    • 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

    $79.31changed to$78.87

    • 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.

  14. July 1, 2015

    RVU15C

    $78.91changed to$79.31

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $76.44changed to$78.91

    • 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
    • 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

    $77.62changed to$76.44

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 2.13 changed to 1.87
    • 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: $77.62

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$93.19$37.47RVU26D
2026-07-01$93.19$37.47RVU26C
2026-04-01$93.19$37.47RVU26B
2026-01-01$93.19$37.47RVU26A
2025-10-01$91.93$44.70RVU25D
2025-07-01$91.93$44.70RVU25C
2025-04-01$91.93$44.70RVU25B
2025-01-01$91.93$44.70RVU25A
2024-10-01$95.94$45.99RVU24D
2024-07-01$95.94$45.99RVU24C
2024-04-01$95.94$45.99RVU24B
2024-03-09$95.94$45.99RVU24AR
2024-01-01$94.37$45.24RVU24A
2023-10-01$98.76$47.18RVU23D
2023-07-01$98.27$47.10RVU23C
2023-04-01$98.27$47.10RVU23B
2023-01-01$98.27$47.10RVU23A
2022-10-01$100.17$47.15RVU22D
2022-07-01$100.17$47.15RVU22C
2022-04-01$100.17$47.15RVU22B
2022-01-01$100.17$47.15RVU22A
2021-10-01$102.06$47.54RVU21D
2021-07-01$102.06$47.54RVU21C
2021-04-01$102.06$47.54RVU21B
2021-01-01$102.06$47.54RVU21A
2020-10-01$101.20$49.54RVU20D
2020-07-01$101.20$49.54RVU20C
2020-04-01$101.20$49.54RVU20B
2020-01-01$101.20$49.54RVU20A
2019-10-01$100.98$50.54RVU19D
2019-07-01$100.98$50.54RVU19C
2019-04-01$100.98$50.54RVU19B
2019-01-01$100.98$50.54RVU19A
2018-10-01$103.77$50.84RVU18D
2018-07-01$103.77$50.84RVU18C
2018-04-01$103.77$50.84RVU18B
2018-01-01$103.77$50.84RVU18AR1
2017-10-01$91.20$46.66RVU17D
2017-07-01$91.20$46.66RVU17C
2017-04-01$91.20$46.66RVU17B
2017-01-01$91.20$46.66RVU17A
2016-10-01$78.87$42.52RVU16D
2016-07-01$78.87$42.52RVU16C
2016-04-01$78.87$42.52RVU16B
2016-01-01$78.87$42.52RVU16A
2015-10-01$79.31$42.57RVU15D
2015-07-01$79.31$42.57RVU15C
2015-04-01$78.91$42.36RVU15B
2015-01-01$78.91$42.36RVU15A
2014-10-01$76.44$41.98RVU14D
2014-07-01$76.44$41.98RVU14C
2014-04-01$76.44$41.98RVU14B
2014-01-01$76.44$41.98RVU14A
2013-10-01$77.62$40.72RVU13D
2013-07-01$77.62$40.72RVU13C
2013-04-01$77.62$40.72RVU13B
2013-01-01$77.62$40.72RVU13AR

Price 69100 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

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 Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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