Billing code 57100: Vaginal biopsyMedicare rate & RVUs
Report this service for a simple biopsy of vaginal mucosa, such as sampling a localized abnormal area for diagnostic evaluation.
Medicare pays $105.21 for 57100 nationally in the office and $58.45 in a hospital or facility. Local office rates run $93.36–$132.09.
Medicare rate · 57100
Vaginal biopsy
Swap in your local Medicare rate.
- Work RVUs
- 1.17
- Total RVUs
- 3.15
- Global days
- 000
National rate · 2026
$105.21
Office setting, before claim adjustments.
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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 57100 covers
A clinician, commonly a gynecologist, takes a limited sample of vaginal mucosa for diagnosis, often from a localized area that appears abnormal on examination. The procedure may be performed in an office or a facility. The tissue is submitted for microscopic evaluation; the biopsy service is distinct from the laboratory’s examination of the specimen when that service is performed.
Choose this code for a simple mucosal biopsy, rather than the more extensive biopsy described by 57105 or an excision such as removal of a vaginal cyst or tumor. Document the sampled site, the reason for biopsy, and the work performed. This minor procedure has a 0-day global period, so same-day preoperative and postoperative care is included. 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% multiple-procedure reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service; 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.
Where 57100 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
$93.36 to $132.09
109 of 109 payment localities
57100 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.
$93.36
$125.27
Color shows the midpoint of each state’s locality range.
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| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $125.27 | 1 |
| AL | $94.68 | 1 |
| AR | $93.36 | 1 |
| AZ | $102.33 | 1 |
| CA | $108.11–$132.09 | 29 |
| CO | $107.83 | 1 |
| CT | $112.06 | 1 |
| DC | $118.62 | 1 |
| DE | $103.96 | 1 |
| FL | $106.32–$118.86 | 3 |
| GA | $100.27–$107.75 | 2 |
| GU | $110.17 | 1 |
| HI | $110.17 | 1 |
| IA | $95.79 | 1 |
| ID | $96.64 | 1 |
| IL | $104.24–$115.30 | 4 |
| IN | $97.14 | 1 |
| KS | $95.92 | 1 |
| KY | $98.06 | 1 |
| LA | $98.14–$102.74 | 2 |
| MA | $107.46–$117.41 | 2 |
| MD | $105.71–$118.62 | 3 |
| ME | $97.73–$101.97 | 2 |
| MI | $101.05–$108.20 | 2 |
| MN | $101.74 | 1 |
| MO | $96.91–$102.41 | 3 |
| MS | $95.12 | 1 |
| MT | $105.20 | 1 |
| NC | $98.62 | 1 |
| ND | $100.85 | 1 |
| NE | $96.12 | 1 |
| NH | $106.70 | 1 |
| NJ | $112.90–$117.58 | 2 |
| NM | $101.81 | 1 |
| NV | $104.04 | 1 |
| NY | $100.09–$125.12 | 5 |
| OH | $100.16 | 1 |
| OK | $97.28 | 1 |
| OR | $102.80–$110.48 | 2 |
| PA | $99.99–$109.74 | 2 |
| PR | $105.75 | 1 |
| RI | $107.10 | 1 |
| SC | $99.64 | 1 |
| SD | $100.33 | 1 |
| TN | $96.46 | 1 |
| TX | $99.40–$107.88 | 8 |
| UT | $100.94 | 1 |
| VA | $102.05–$118.62 | 2 |
| VI | $105.75 | 1 |
| VT | $100.99 | 1 |
| WA | $107.08–$119.17 | 2 |
| WI | $97.66 | 1 |
| WV | $100.68 | 1 |
| WY | $103.30 | 1 |
How the 57100 rate is calculated
Each of 57100’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 · 57100
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.17Practice expense 1.76Malpractice 0.22
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 57100
The CMS indicators that decide how 57100 is paid alongside other services.
CMS payment indicators · 57100
Vaginal 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
57100 without 51 · national office
$105.21
Vaginal biopsy
57100-51 · Second procedure: 50%
$52.61
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%).
57100 compared with similar codes
Compare codes
57100 vs 57105 vs 57135 vs 57421: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 57105Vaginal biopsy
- 57100 represents simple vaginal mucosal sampling. 57105 is for an extensive biopsy, so the documented extent determines the choice.
- 57135Vaginal lesion excision
- 57135 describes excision of a vaginal cyst or tumor. Use 57100 when the service is a simple mucosal biopsy rather than removal of the lesion.
- 57421Colposcopy
- 57421 is vaginal colposcopy with biopsy when performed. Do not add 57100 for a biopsy included in that colposcopy service.
57100 billing questions
When should 57100 be chosen instead of 57105?
Use 57100 for a simple, limited vaginal mucosal biopsy. Use 57105 when the documented biopsy is extensive.
Can the pathology examination be reported separately?
The biopsy is the tissue-sampling service. When a laboratory performs microscopic examination of the specimen, that pathology service may be reported separately, such as with 88305 when the specimen and service meet that code’s criteria.
Can 57100 be reported with vaginal colposcopy code 57421?
Code 57421 includes vaginal or cervical biopsy when performed as part of the colposcopy service. Do not separately report 57100 for that same biopsy.
Is modifier 50 appropriate for biopsies from both sides of the vagina?
No. CMS identifies bilateral adjustment as inappropriate for 57100; modifier 50 should not be used.
What documentation supports 57100?
Record the vaginal site sampled, the clinical reason for sampling, and that a simple mucosal biopsy was performed. The operative or procedure note should distinguish sampling from a more extensive biopsy or excision.
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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