$133.74
56820 describes vulvar colposcopy without biopsy. Choose 56821 when the colposcopic examination includes a directed biopsy.
On this page
CMS RVU26D · Effective 2026-10-01
56821 Vulvar colposcopy Medicare reimbursement rates in Guam
Reports magnified examination of vulvar tissue with targeted biopsy when evaluating suspicious lesions or abnormal vulvar findings. Compare 56821 office and facility rates across CMS payment localities in Guam.
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 56821 in Guam?
Guam has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$178.21
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
Facility setting
$98.84
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
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 56821: Vulvar colposcopy with biopsy
Reports magnified examination of vulvar tissue with targeted biopsy when evaluating suspicious lesions or abnormal vulvar findings.
Vulvar colposcopy with biopsy uses magnification and directed inspection of the vulvar surface, often after application of acetic acid, to identify abnormal epithelium and obtain tissue. Gynecologists commonly perform it in an office or outpatient setting when lesions or abnormal vulvar findings require histologic evaluation, including concern for vulvar intraepithelial neoplasia. The sampled tissue is sent for pathology; the code represents the examination and biopsy in the same service.
Report 56821 when the colposcopic vulvar examination includes one or more directed biopsies; use 56820 when the examination has no biopsy. Record the indication, vulvar site and appearance, colposcopic findings, biopsy locations, and specimen submission. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in one session, the highest-valued procedure is paid in full and others are paid at 50%. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service; co-surgery and team surgery are not permitted.
CMS billing rules for 56821
- 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 not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU2.00 · 39%
- Practice expense (office) RVU2.74 · 54%
- Malpractice RVU0.38 · 7%
2K
Medicare services in 2024 · #2445 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.
56821 compared with similar codes
Office rates for Guam, from the same CMS release.
$97.90
56605 is a vulvar or perineal biopsy without the colposcopic service. 56821 includes colposcopic examination with biopsy.
$167.46
57455 is a colposcopic biopsy service for the cervix. Use 56821 when the biopsied site is vulvar tissue.
Compare 56821 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.
1 of 1 payment localities
Hawaii, Guam →
Office / nonfacility
$178.21
Facility
$98.84
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 56821 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
6,427
- Code
- 56821
- Physician work
- 2.00
- Practice expense
- 2.74
- Malpractice
- 0.38
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.00 | × 1.000 | 2.0000 |
| Practice expense | 2.74 | × 1.137 | 3.1154 |
| Malpractice | 0.38 | × 0.579 | 0.2200 |
| Total RVUs | 5.3354 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Hawaii, Guam$178.21
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2 | 1 |
| Practice expense | 2.74 | 1.137 |
| Malpractice | 0.38 | 0.579 |
(2 × 1 + 2.74 × 1.137 + 0.38 × 0.579) × $33.4009 = $178.21
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2 | 1 |
| Practice expense | 0.65 | 1.137 |
| Malpractice | 0.38 | 0.579 |
(2 × 1 + 0.65 × 1.137 + 0.38 × 0.579) × $33.4009 = $98.84
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
56821 billing questions
When should 56821 be chosen over 56820?
Use 56821 when the vulvar colposcopic examination includes a directed biopsy. Use 56820 for the examination without biopsy.
Is the biopsy separately reportable?
The biopsy is included in 56821 when performed as part of the vulvar colposcopic service. Do not separately report a vulvar biopsy code for that same biopsy.
Should modifier 50 be appended?
No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 is not appropriate.
How does CMS handle other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures in the session are paid at 50% under the standard multiple-procedure reduction.
What documentation supports reporting 56821?
Document the reason for examination, vulvar findings and biopsy site or sites, and that tissue was obtained and submitted for pathology.
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.
6,42456805,,Clitoroplasty intersex state,A,,19.38,7.89,NA,7.89,,3.39,30.66,30.66,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,42556810,,Perineoplasty rpr per nonob,A,,4.18,2.33,NA,2.33,,0.71,7.22,7.22,0,010,0.10,0.80,0.10,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,42656820,,Colposcopy vulva,A,,1.46,2.10,,0.53,,0.27,3.83,2.26,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,42756821,,Colposcopy vulva w/biopsy,A,,2.00,2.74,,0.65,,0.38,5.12,3.03,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,42857000,,Colpotomy w/exploration,A,,2.94,1.90,NA,1.90,,0.50,5.34,5.34,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,42957010,,Colpotomy drg pel abscess,A,,6.67,4.39,NA,4.39,,1.17,12.23,12.23,0,090,0.12,0.74,0.14,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,43057020,,Colpocentesis sep px,A,,1.46,1.87,,0.35,,0.25,3.58,2.06,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014