Billing code 54100: BiopsyMedicare rate & RVUs
A clinician samples penile tissue to evaluate a suspicious lesion, ulcer, or plaque when diagnosis requires histologic examination.
Medicare pays $203.08 for 54100 nationally in the office and $103.88 in a hospital or facility. Local office rates run $180.86–$266.27.
Medicare rate · 54100
Biopsy
- Work RVUs
- 1.85
- Total RVUs
- 6.08
- Global days
- 000
National rate · 2026
$203.08
Office setting, before claim adjustments.
See every locality for 54100 →Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 10 sections
What 54100 covers
A urologist or other qualified clinician takes a tissue sample from the penis to investigate a finding such as a persistent ulcer, atypical plaque, or suspected neoplasm. The procedure is commonly performed in an office or outpatient setting, often with local anesthesia. The tissue is sent for microscopic examination to help establish a diagnosis; this code represents the biopsy, not therapeutic removal of a lesion.
Report this code for a penile biopsy that is not the deeper sampling represented by 54105. The record should identify the sampled site, the lesion or clinical concern, and the biopsy performed. Same-day preoperative and postoperative care is included in this 0-day global period. If other procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% multiple-procedure reduction. Do not append modifier 50; CMS treats bilateral adjustment as inappropriate for this code. Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery reporting 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 54100 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$180.86 to $266.27
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $183.35 | $96.55 |
| Alaska* | $239.72 | $134.07 |
| Arizona | $197.94 | $101.82 |
| Arkansas | $180.86 | $95.64 |
| Atlanta | $206.76 | $105.97 |
| Austin | $210.25 | $105.29 |
| Bakersfield | $214.56 | $105.84 |
| Baltimore/Surr. Cntys | $215.48 | $109.03 |
| Beaumont | $190.49 | $100.22 |
| Brazoria | $200.89 | $102.58 |
| Chicago | $212.83 | $113.14 |
| Chico | $213.95 | $105.23 |
| Colorado | $210.97 | $105.42 |
| Connecticut | $216.08 | $109.24 |
| Dallas | $202.15 | $103.34 |
| Dc + Md/Va Suburbs | $231.13 | $114.27 |
| Delaware | $201.10 | $103.09 |
| Detroit | $202.95 | $107.22 |
| East St. Louis | $199.08 | $107.82 |
| El Centro | $213.98 | $105.26 |
| Fort Lauderdale | $210.22 | $109.73 |
| Fort Worth | $200.89 | $103.08 |
| Fresno | $213.95 | $105.23 |
| Galveston | $201.48 | $102.97 |
| Hanford-Corcoran | $213.95 | $105.23 |
| Hawaii, Guam | $218.71 | $105.91 |
| Houston | $205.14 | $106.64 |
| Idaho | $188.79 | $97.52 |
| Indiana | $189.82 | $97.86 |
| Iowa | $187.61 | $96.84 |
| Kansas | $186.84 | $97.16 |
| Kentucky | $187.57 | $99.38 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $228.00 | $110.64 |
| Madera | $213.95 | $105.23 |
| Manhattan | $232.75 | $117.48 |
| Merced | $213.95 | $105.23 |
| Metropolitan Boston | $230.99 | $112.54 |
| Metropolitan Kansas City | $194.71 | $101.56 |
| Metropolitan Philadelphia | $211.00 | $107.73 |
| Metropolitan St. Louis | $196.63 | $102.19 |
| Miami | $218.81 | $115.54 |
| Minnesota | $202.28 | $100.20 |
| Mississippi | $182.62 | $97.21 |
| Modesto | $213.95 | $105.23 |
| Montana** | $203.06 | $103.86 |
| Napa | $246.49 | $115.74 |
| Nebraska | $188.56 | $97.00 |
| Nevada** | $202.10 | $102.80 |
| New Hampshire | $207.76 | $104.49 |
| New Mexico | $193.25 | $102.28 |
| New Orleans | $196.04 | $102.70 |
| North Carolina | $191.65 | $99.09 |
| North Dakota** | $199.11 | $99.91 |
| Northern Nj | $228.96 | $113.89 |
| Nyc Suburbs/Long Island | $238.20 | $120.25 |
| Ohio | $191.42 | $100.85 |
| Oklahoma | $187.18 | $98.60 |
| Oxnard-Thousand Oaks-Ventura | $226.79 | $109.53 |
| Portland | $217.30 | $107.09 |
| Poughkpsie/N Nyc Suburbs | $220.05 | $111.42 |
| Puerto Rico | $204.46 | $104.17 |
| Queens | $234.48 | $117.23 |
| Redding | $213.95 | $105.23 |
| Rest Of California | $213.95 | $105.23 |
| Rest Of Florida | $200.51 | $105.68 |
| Rest Of Georgia | $189.82 | $101.34 |
| Rest Of Illinois | $195.13 | $104.56 |
| Rest Of Louisiana | $187.32 | $99.52 |
| Rest Of Maine | $189.78 | $98.52 |
| Rest Of Maryland | $204.76 | $104.37 |
| Rest Of Massachusetts | $209.84 | $105.39 |
| Rest Of Michigan | $192.23 | $101.66 |
| Rest Of Missouri | $184.33 | $98.82 |
| Rest Of New Jersey | $218.58 | $110.25 |
| Rest Of New York | $194.36 | $100.12 |
| Rest Of Oregon | $200.56 | $101.75 |
| Rest Of Pennsylvania | $191.67 | $100.61 |
| Rest Of Texas | $195.56 | $101.42 |
| Rest Of Washington | $209.42 | $104.96 |
| Rhode Island | $207.97 | $105.50 |
| Riverside-San Bernardino-Ontario | $216.13 | $107.41 |
| Sacramento-Roseville-Folsom | $224.14 | $108.77 |
| Salinas | $223.30 | $108.32 |
| San Diego-Chula Vista-Carlsbad | $228.25 | $109.61 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $260.52 | $120.65 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $260.29 | $120.42 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $266.27 | $123.22 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $265.34 | $122.29 |
| San Luis Obispo-Paso Robles | $219.74 | $106.75 |
| Santa Cruz-Watsonville | $230.22 | $109.69 |
| Santa Maria-Santa Barbara | $224.05 | $108.38 |
| Santa Rosa-Petaluma | $232.52 | $110.70 |
| Seattle (King Cnty) | $235.50 | $113.78 |
| South Carolina | $191.85 | $100.18 |
| South Dakota** | $198.64 | $99.44 |
| Southern Maine | $199.40 | $101.09 |
| Stockton | $213.95 | $105.23 |
| Suburban Chicago | $212.30 | $110.42 |
| Tennessee | $187.74 | $97.56 |
| Utah | $194.32 | $101.07 |
| Vallejo | $246.16 | $115.41 |
| Vermont | $198.43 | $100.22 |
| Virgin Islands | $204.46 | $104.17 |
| Virginia | $198.83 | $101.31 |
| Visalia | $213.95 | $105.23 |
| West Virginia | $188.32 | $102.12 |
| Wisconsin | $192.80 | $97.77 |
| Wyoming** | $201.34 | $102.14 |
| Yuba City | $213.95 | $105.23 |
54100 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$180.86
$240.11
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $239.72 | 1 |
| AL | $183.35 | 1 |
| AR | $180.86 | 1 |
| AZ | $197.94 | 1 |
| CA | $213.95–$266.27 | 29 |
| CO | $210.97 | 1 |
| CT | $216.08 | 1 |
| DC | $231.13 | 1 |
| DE | $201.10 | 1 |
| FL | $200.51–$218.81 | 3 |
| GA | $189.82–$206.76 | 2 |
| GU | $218.71 | 1 |
| HI | $218.71 | 1 |
| IA | $187.61 | 1 |
| ID | $188.79 | 1 |
| IL | $195.13–$212.83 | 4 |
| IN | $189.82 | 1 |
| KS | $186.84 | 1 |
| KY | $187.57 | 1 |
| LA | $187.32–$196.04 | 2 |
| MA | $209.84–$230.99 | 2 |
| MD | $204.76–$231.13 | 3 |
| ME | $189.78–$199.40 | 2 |
| MI | $192.23–$202.95 | 2 |
| MN | $202.28 | 1 |
| MO | $184.33–$196.63 | 3 |
| MS | $182.62 | 1 |
| MT | $203.06 | 1 |
| NC | $191.65 | 1 |
| ND | $199.11 | 1 |
| NE | $188.56 | 1 |
| NH | $207.76 | 1 |
| NJ | $218.58–$228.96 | 2 |
| NM | $193.25 | 1 |
| NV | $202.10 | 1 |
| NY | $194.36–$238.20 | 5 |
| OH | $191.42 | 1 |
| OK | $187.18 | 1 |
| OR | $200.56–$217.30 | 2 |
| PA | $191.67–$211.00 | 2 |
| PR | $204.46 | 1 |
| RI | $207.97 | 1 |
| SC | $191.85 | 1 |
| SD | $198.64 | 1 |
| TN | $187.74 | 1 |
| TX | $190.49–$210.25 | 8 |
| UT | $194.32 | 1 |
| VA | $198.83–$231.13 | 2 |
| VI | $204.46 | 1 |
| VT | $198.43 | 1 |
| WA | $209.42–$235.50 | 2 |
| WI | $192.80 | 1 |
| WV | $188.32 | 1 |
| WY | $201.34 | 1 |
How the 54100 rate is calculated
Each of 54100’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 · 54100
RVUs × geographic indexes × conversion factor
Work1.85
1.85 RVUs× 1.000 GPCI
Practice expense4.03
4.03 RVUs× 1.000 GPCI
Malpractice0.20
0.20 RVUs× 1.000 GPCI
Adjusted RVUs
6.0800
Conversion factor
$33.4009
Medicare rate
$203.08
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 54100
The CMS indicators that decide how 54100 is paid alongside other services.
CMS payment indicators · 54100
Biopsy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
54100 without 51 · national office
$203.08
Biopsy
54100-51 · Second procedure: 50%
$101.54
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%).
54100 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 54105Penile biopsy
- 54100 describes a penile biopsy that is not deep; 54105 is the sibling code for deep penile tissue sampling.
- 54110Penile lesion treatment
- 54100 obtains tissue for diagnosis. Use the applicable lesion-treatment code when the service treats the penile lesion rather than sampling it.
- 54120Penile surgery
- 54100 is a diagnostic tissue-sampling service. 54120 describes partial removal of the penis, a substantially more extensive therapeutic operation.
54100 billing questions
How is 54100 distinguished from 54105?
Use 54100 for a penile biopsy that is not deep. Use 54105 when the documented service is a deep penile biopsy.
Can the lesion be removed instead of biopsied?
This code describes tissue sampling for diagnosis, not treatment of the lesion. When the service treats a penile lesion rather than obtaining a diagnostic sample, consider the applicable lesion-treatment code, such as 54110.
Is the pathology examination included?
The biopsy code represents obtaining the tissue. A laboratory or pathologist may separately report the histopathology service, such as 88305, when performed.
Should modifier 50 be reported for multiple penile biopsy sites?
No. CMS identifies bilateral adjustment as inappropriate for this code, so do not append modifier 50.
How are same-session procedures paid?
When other procedures are performed in the same session, the highest-valued procedure is paid in full and the remaining procedures are subject to the standard 50% multiple-procedure reduction.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for 54100. 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
Fee sheets
Put 54100 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →