$37.71–$40.03
56605 covers the first lesion sampled; 56606 reports each additional separately biopsied lesion.
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CMS RVU26D · Effective 2026-10-01
56605 Vulvar biopsy Medicare reimbursement rates in Georgia
Report this procedure when a clinician samples a single vulvar or perineal lesion for tissue diagnosis rather than removing vulvar tissue definitively. Compare 56605 office and facility rates across CMS payment localities in Georgia.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 56605 in Georgia?
Georgia has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$89.19–$95.73
2 of 2 localities have a supported rate.
Facility setting
$51.94–$53.31
2 of 2 localities have a supported rate.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Gynecology procedure
About 56605: Single vulvar or perineal lesion biopsy
Report this procedure when a clinician samples a single vulvar or perineal lesion for tissue diagnosis rather than removing vulvar tissue definitively.
A clinician takes tissue from one vulvar or perineal lesion for histopathologic evaluation, often using a punch or incisional sample when examination findings or symptoms warrant diagnosis. Gynecologists and other clinicians managing vulvar disease may perform the biopsy in an office procedure room or facility. Common reasons include evaluating a persistent ulcer, an abnormal pigmented area, focal thickening, or a lesion concerning for vulvar intraepithelial neoplasia or malignancy.
Report 56605 for the first lesion sampled and 56606 for each additional separately biopsied lesion. Document the lesion site and number, the clinical reason for sampling, and the biopsy performed. The 0-day global period includes same-day preoperative and postoperative care. When multiple procedures are performed in the same session, the highest-valued is paid in full and others are subject to the standard 50% reduction. Modifier 50 is inappropriate, even for lesions on both sides. CMS does not pay an assistant at surgery for this service; co-surgeons are permitted, but team surgery is not.
CMS billing rules for 56605
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU1.07 · 38%
- Practice expense (office) RVU1.54 · 55%
- Malpractice RVU0.19 · 7%
26.3K
Medicare services in 2024 · #1029 by national volume
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.
56605 compared with similar codes
Office rates for Georgia, from the same CMS release.
$163.57–$175.23
Choose 56821 when vulvar colposcopy with biopsy is performed; 56605 describes biopsy without that colposcopy service.
No office rate
56620 describes definitive partial vulvar removal. Use 56605 when tissue is sampled for diagnosis rather than removing vulvar tissue as treatment.
Compare 56605 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
2 of 2 payment localities
Atlanta →
Office / nonfacility
$95.73
Facility
$53.31
Rest Of Georgia →
Office / nonfacility
$89.19
Facility
$51.94
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56605 billing questions
When should 56606 be reported instead?
Use 56605 for the first lesion biopsied. Report 56606 for each additional, separately sampled lesion.
Can modifier 50 be used for lesions on both sides?
No. The bilateral adjustment does not apply, and modifier 50 is inappropriate for this service.
Is the pathology examination included?
The code covers obtaining the biopsy tissue. Histologic examination is a separate laboratory service when performed and reported by the responsible laboratory.
What documentation supports the code?
Record the vulvar or perineal site, the number of lesions sampled, the clinical reason for biopsy, and the procedure performed.
How does CMS handle other procedures performed in the same session?
The highest-valued procedure is paid in full, with the other procedures subject to the standard multiple procedure reduction. Same-day preoperative and postoperative care is included in the 0-day global period.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
6,40756442,,Hymenotomy,A,,0.66,0.53,NA,0.53,,0.12,1.31,1.31,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,40856501,,Destroy vulva lesions sim,A,,1.54,3.75,,1.80,,0.25,5.54,3.59,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,40956515,,Destroy vulva lesion/s compl,A,,3.00,4.67,,2.18,,0.51,8.18,5.69,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,41056605,,Biopsy of vulva/perineum,A,,1.07,1.54,,0.29,,0.19,2.80,1.55,0,000,0.00,0.00,0.00,2,0,1,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,41156606,,Biopsy of vulva/perineum,A,,0.54,0.54,,0.13,,0.09,1.17,0.76,0,ZZZ,0.00,0.00,0.00,0,0,1,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,41256620,,Vulvectomy simple partial,A,,7.34,7.52,NA,7.52,,1.51,16.37,16.37,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,41356625,,Vulvectomy simple complete,A,,9.44,7.18,NA,7.18,,1.98,18.60,18.60,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00