$86.51
56605 reports the primary vulvar or perineal lesion biopsy; 56606 reports each additional distinct lesion and must accompany the primary code.
On this page
CMS RVU26D · Effective 2026-10-01
56606 Vulvar biopsy Medicare reimbursement rates in Indiana
Reports biopsy sampling of each additional vulvar or perineal lesion after the primary lesion biopsy, such as when several distinct lesions require tissue diagnosis. Compare 56606 office and facility rates across CMS payment localities in Indiana.
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 56606 in Indiana?
Indiana 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
$36.22
1 of 1 localities have a supported rate.
Payment area: Indiana
One mapped payment locality.
Facility setting
$23.52
1 of 1 localities have a supported rate.
Payment area: Indiana
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
About 56606: Additional vulvar or perineal lesion biopsy
Reports biopsy sampling of each additional vulvar or perineal lesion after the primary lesion biopsy, such as when several distinct lesions require tissue diagnosis.
This add-on represents tissue sampling from an additional, distinct lesion of the vulva or perineum after the primary lesion has been biopsied. A gynecologist or another clinician performing vulvar evaluation may obtain the specimen in an office, procedure room, or operating room. The tissue is typically submitted for histopathologic examination to investigate findings such as a persistent lesion or an area of abnormal vulvar tissue.
Report 56606 with the primary biopsy code 56605, not by itself, when a separate additional lesion is sampled. The record should identify the lesions and support that more than one distinct site was biopsied; repeated sampling of the same lesion is not an additional lesion. CMS classifies 56606 as an add-on code: it is billed only with a primary procedure and paid within that procedure's global period. The code does not represent a vulvectomy or removal of a larger area of vulvar tissue.
CMS billing rules for 56606
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
Where the value comes from
- Work RVU0.54 · 46%
- Practice expense (office) RVU0.54 · 46%
- Malpractice RVU0.09 · 8%
5K
Medicare services in 2024 · #1868 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.
56606 compared with similar codes
Office rates for Indiana, from the same CMS release.
$113.04
11104 is for punch biopsy of a skin lesion in a different anatomic circumstance. Vulvar or perineal lesion biopsies are represented by the 56605/56606 code pair.
No office rate
56620 describes a simple partial vulvectomy, which removes vulvar tissue rather than sampling an additional lesion for diagnosis.
Compare 56606 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
Indiana →
Office / nonfacility
$36.22
Facility
$23.52
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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 56606 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
6,411
- Code
- 56606
- Physician work
- 0.54
- Practice expense
- 0.54
- Malpractice
- 0.09
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.54 | × 1.000 | 0.5400 |
| Practice expense | 0.54 | × 0.927 | 0.5006 |
| Malpractice | 0.09 | × 0.486 | 0.0437 |
| Total RVUs | 1.0843 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Indiana$36.22
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.54 | 1 |
| Practice expense | 0.54 | 0.927 |
| Malpractice | 0.09 | 0.486 |
(0.54 × 1 + 0.54 × 0.927 + 0.09 × 0.486) × $33.4009 = $36.22
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.54 | 1 |
| Practice expense | 0.13 | 0.927 |
| Malpractice | 0.09 | 0.486 |
(0.54 × 1 + 0.13 × 0.927 + 0.09 × 0.486) × $33.4009 = $23.52
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.
56606 billing questions
When should 56606 be used instead of 56605?
Use 56605 for the primary lesion biopsy. Use 56606 for each additional distinct vulvar or perineal lesion biopsied during the service.
Can 56606 be reported by itself?
No. It is an add-on code and must be reported with the primary biopsy procedure, 56605.
What documentation supports an additional lesion?
Document the distinct lesion sites or describe how the sampled areas differ, along with the biopsy performed at each site.
How should units be determined?
Count additional distinct lesions biopsied beyond the primary lesion. Do not count multiple samples from one lesion as additional lesions.
Is a pathology examination included in 56606?
56606 describes the biopsy procedure. Histopathology of submitted tissue is a separate service when performed and reportable by the responsible pathology provider.
Does the add-on code have its own global period?
CMS pays 56606 within the primary procedure's global period; report it only with that primary procedure.
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.
6,40856501,,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
6,41456630,,Vulvectomy radical partial,A,,14.43,9.27,NA,9.27,,3.18,26.88,26.88,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915