Billing code 56405: Abscess drainageMedicare rate & RVUs
Reports incision and drainage of an abscess in the vulva or perineum, excluding a Bartholin gland abscess coded to its specific procedure.
Medicare pays $145.96 for 56405 nationally in the office and $116.90 in a hospital or facility. Local office rates run $129.22–$186.53.
Medicare rate · 56405
Abscess drainage
Swap in your local Medicare rate.
- Work RVUs
- 1.45
- Total RVUs
- 4.37
- Global days
- 010
National rate · 2026
$145.96
Office setting, before claim adjustments.
See every locality for 56405 → · 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 56405 covers
A clinician incises and drains a localized collection of pus in the vulvar or perineal tissues. The service may be performed by a gynecologist, family physician, or other qualified clinician in an office or facility setting. A vulvar soft-tissue abscess is an example; an abscess of the Bartholin gland has its own code. The documented site should distinguish the treated abscess from a Bartholin gland abscess and from an abscess elsewhere on the skin.
Report 56405 when the abscess is in the vulva or perineum and the service is incision and drainage. The record should identify the anatomic location and describe the drainage procedure. Related postoperative visits during the 10-day global period are included. When multiple procedures occur 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; co-surgeons are permitted, while team surgery is 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 56405 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
$129.22 to $186.53
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $131.09 | $105.66 |
| Alaska* | $172.05 | $141.11 |
| Arizona | $141.96 | $113.80 |
| Arkansas | $129.22 | $104.26 |
| Atlanta | $149.27 | $119.75 |
| Austin | $150.22 | $119.48 |
| Bakersfield | $152.02 | $120.17 |
| Baltimore/Surr. Cntys | $155.28 | $124.10 |
| Beaumont | $137.35 | $110.91 |
| Brazoria | $143.64 | $114.84 |
| Chicago | $157.99 | $128.79 |
| Chico | $151.29 | $119.44 |
| Colorado | $150.33 | $119.41 |
| Connecticut | $155.60 | $124.30 |
| Dallas | $144.81 | $115.87 |
| Dc + Md/Va Suburbs | $165.37 | $131.14 |
| Delaware | $144.26 | $115.55 |
| Detroit | $148.81 | $120.77 |
| East St. Louis | $147.66 | $120.93 |
| El Centro | $151.33 | $119.48 |
| Fort Lauderdale | $154.13 | $124.70 |
| Fort Worth | $144.03 | $115.38 |
| Fresno | $151.29 | $119.44 |
| Galveston | $144.23 | $115.38 |
| Hanford-Corcoran | $151.29 | $119.44 |
| Hawaii, Guam | $154.48 | $121.44 |
| Houston | $148.99 | $120.14 |
| Idaho | $134.28 | $107.54 |
| Indiana | $135.01 | $108.07 |
| Iowa | $133.17 | $106.58 |
| Kansas | $133.13 | $106.86 |
| Kentucky | $135.36 | $109.53 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $161.29 | $126.91 |
| Madera | $151.29 | $119.44 |
| Manhattan | $168.54 | $134.78 |
| Merced | $151.29 | $119.44 |
| Metropolitan Boston | $164.23 | $129.53 |
| Metropolitan Kansas City | $140.34 | $113.06 |
| Metropolitan Philadelphia | $152.15 | $121.90 |
| Metropolitan St. Louis | $141.71 | $114.05 |
| Miami | $162.88 | $132.63 |
| Minnesota | $142.42 | $112.52 |
| Mississippi | $131.35 | $106.33 |
| Modesto | $151.29 | $119.44 |
| Montana** | $145.94 | $116.89 |
| Napa | $172.99 | $134.69 |
| Nebraska | $133.72 | $106.90 |
| Nevada** | $144.60 | $115.51 |
| New Hampshire | $148.52 | $118.27 |
| New Mexico | $140.33 | $113.69 |
| New Orleans | $141.90 | $114.56 |
| North Carolina | $136.87 | $109.76 |
| North Dakota** | $140.80 | $111.74 |
| Northern Nj | $163.82 | $130.11 |
| Nyc Suburbs/Long Island | $173.30 | $138.75 |
| Ohio | $138.30 | $111.77 |
| Oklahoma | $134.52 | $108.57 |
| Oxnard-Thousand Oaks-Ventura | $160.21 | $125.87 |
| Portland | $154.38 | $122.09 |
| Poughkpsie/N Nyc Suburbs | $158.41 | $126.59 |
| Puerto Rico | $146.81 | $117.43 |
| Queens | $169.07 | $134.72 |
| Redding | $151.29 | $119.44 |
| Rest Of California | $151.29 | $119.44 |
| Rest Of Florida | $146.42 | $118.64 |
| Rest Of Georgia | $138.03 | $112.11 |
| Rest Of Illinois | $143.12 | $116.59 |
| Rest Of Louisiana | $135.38 | $109.66 |
| Rest Of Maine | $135.57 | $108.84 |
| Rest Of Maryland | $146.80 | $117.39 |
| Rest Of Massachusetts | $149.68 | $119.08 |
| Rest Of Michigan | $139.35 | $112.82 |
| Rest Of Missouri | $133.48 | $108.43 |
| Rest Of New Jersey | $156.92 | $125.18 |
| Rest Of New York | $138.94 | $111.33 |
| Rest Of Oregon | $143.03 | $114.08 |
| Rest Of Pennsylvania | $138.20 | $111.52 |
| Rest Of Texas | $140.59 | $113.01 |
| Rest Of Washington | $149.22 | $118.63 |
| Rhode Island | $148.88 | $118.86 |
| Riverside-San Bernardino-Ontario | $154.09 | $122.24 |
| Sacramento-Roseville-Folsom | $158.16 | $124.36 |
| Salinas | $157.56 | $123.88 |
| San Diego-Chula Vista-Carlsbad | $160.85 | $126.10 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $182.29 | $141.32 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $182.00 | $141.02 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $186.53 | $144.63 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $185.32 | $143.42 |
| San Luis Obispo-Paso Robles | $155.11 | $122.01 |
| Santa Cruz-Watsonville | $162.05 | $126.75 |
| Santa Maria-Santa Barbara | $158.04 | $124.15 |
| Santa Rosa-Petaluma | $163.64 | $127.96 |
| Seattle (King Cnty) | $166.96 | $131.31 |
| South Carolina | $137.91 | $111.06 |
| South Dakota** | $140.20 | $111.14 |
| Southern Maine | $141.96 | $113.16 |
| Stockton | $151.29 | $119.44 |
| Suburban Chicago | $155.40 | $125.56 |
| Tennessee | $133.86 | $107.44 |
| Utah | $139.75 | $112.43 |
| Vallejo | $172.57 | $134.27 |
| Vermont | $140.78 | $112.02 |
| Virgin Islands | $146.81 | $117.43 |
| Virginia | $141.90 | $113.33 |
| Visalia | $151.29 | $119.44 |
| West Virginia | $138.07 | $112.81 |
| Wisconsin | $136.22 | $108.38 |
| Wyoming** | $143.70 | $114.65 |
| Yuba City | $151.29 | $119.44 |
56405 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.
$129.22
$172.05
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 | $172.05 | 1 |
| AL | $131.09 | 1 |
| AR | $129.22 | 1 |
| AZ | $141.96 | 1 |
| CA | $151.29–$186.53 | 29 |
| CO | $150.33 | 1 |
| CT | $155.60 | 1 |
| DC | $165.37 | 1 |
| DE | $144.26 | 1 |
| FL | $146.42–$162.88 | 3 |
| GA | $138.03–$149.27 | 2 |
| GU | $154.48 | 1 |
| HI | $154.48 | 1 |
| IA | $133.17 | 1 |
| ID | $134.28 | 1 |
| IL | $143.12–$157.99 | 4 |
| IN | $135.01 | 1 |
| KS | $133.13 | 1 |
| KY | $135.36 | 1 |
| LA | $135.38–$141.90 | 2 |
| MA | $149.68–$164.23 | 2 |
| MD | $146.80–$165.37 | 3 |
| ME | $135.57–$141.96 | 2 |
| MI | $139.35–$148.81 | 2 |
| MN | $142.42 | 1 |
| MO | $133.48–$141.71 | 3 |
| MS | $131.35 | 1 |
| MT | $145.94 | 1 |
| NC | $136.87 | 1 |
| ND | $140.80 | 1 |
| NE | $133.72 | 1 |
| NH | $148.52 | 1 |
| NJ | $156.92–$163.82 | 2 |
| NM | $140.33 | 1 |
| NV | $144.60 | 1 |
| NY | $138.94–$173.30 | 5 |
| OH | $138.30 | 1 |
| OK | $134.52 | 1 |
| OR | $143.03–$154.38 | 2 |
| PA | $138.20–$152.15 | 2 |
| PR | $146.81 | 1 |
| RI | $148.88 | 1 |
| SC | $137.91 | 1 |
| SD | $140.20 | 1 |
| TN | $133.86 | 1 |
| TX | $137.35–$150.22 | 8 |
| UT | $139.75 | 1 |
| VA | $141.90–$165.37 | 2 |
| VI | $146.81 | 1 |
| VT | $140.78 | 1 |
| WA | $149.22–$166.96 | 2 |
| WI | $136.22 | 1 |
| WV | $138.07 | 1 |
| WY | $143.70 | 1 |
How the 56405 rate is calculated
Each of 56405’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 · 56405
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.45Practice expense 2.66Malpractice 0.26
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 56405
56405 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 56405
Abscess drainage
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are 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) | 2 | Permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 56405
Abscess drainage
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
56405 without 51 · national office
$145.96
Abscess drainage
56405-51 · Second procedure: 50%
$72.98
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%).
56405 compared with similar codes
Compare codes
56405 vs 56420 vs 10060 vs 10061 vs 56440: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 56420Abscess drainage
- 56420 identifies drainage of a Bartholin gland abscess. Choose 56405 for a vulvar or perineal abscess that does not involve that gland.
- 10060Abscess drainage
- 10060 is the general code for incision and drainage of a simple or single abscess. 56405 identifies the vulvar or perineal site.
- 10061Abscess drainage
- 10061 is the general code for complicated or multiple abscesses. 56405 is specific to a vulvar or perineal abscess.
- 56440Cyst marsupialization
- 56440 describes marsupialization of a Bartholin gland cyst, a different procedure from draining a vulvar or perineal abscess.
56405 billing questions
When should 56405 be used instead of 56420?
Use 56405 for an abscess in vulvar or perineal tissue. Use 56420 when the abscess involves the Bartholin gland.
What documentation supports 56405?
Document the abscess location in the vulva or perineum and the incision-and-drainage service performed. Clarify whether the Bartholin gland is involved.
Can modifier 50 be reported?
No. The descriptor and anatomy make modifier 50 inappropriate for this code.
Are related postoperative visits separately reported?
Related postoperative visits during the 10-day global period are included in the procedure.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures are subject to the standard multiple procedure reduction.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeons are permitted, but team surgery is not.
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
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