$133.85
Choose 69100 for biopsy of the visible external ear, such as the pinna; choose 69105 when the sampled tissue is in the external auditory canal.
On this page
CMS RVU26D · Effective 2026-10-01
69100 Ear biopsy Medicare reimbursement rates in Indiana
Reports tissue sampling of a lesion on the visible external ear, such as the pinna, for histologic diagnosis rather than ear-canal biopsy. Compare 69100 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 69100 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
$86.66
1 of 1 localities have a supported rate.
Payment area: Indiana
One mapped payment locality.
Facility setting
$35.57
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.
Otolaryngology procedure
About 69100: External ear lesion biopsy
Reports tissue sampling of a lesion on the visible external ear, such as the pinna, for histologic diagnosis rather than ear-canal biopsy.
This service obtains tissue from the visible external ear, such as the auricle or pinna, when a lesion requires histologic diagnosis. Otolaryngologists and dermatologists commonly perform it in an office or procedure room. The sampled structure distinguishes this code from a biopsy of the external auditory canal: a lesion on the pinna is the relevant site, not a lesion deeper in the canal.
Choose the code according to the biopsy site and service performed. Document the exact ear subsite, lesion, reason for sampling, and procedure performed. A 0-day global period includes same-day preoperative and postoperative care. 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% reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
CMS billing rules for 69100
- 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 RVU0.79 · 29%
- Practice expense (office) RVU1.91 · 69%
- Malpractice RVU0.07 · 3%
170.2K
Medicare services in 2024 · #415 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.
69100 compared with similar codes
Office rates for Indiana, from the same CMS release.
$436.05
69100 reports diagnostic tissue sampling. 69110 describes partial external-ear removal when the service is excision rather than biopsy.
No office rate
69140 is for removal of a lesion in the ear canal. 69100 is for biopsy of the visible external ear.
Compare 69100 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
$86.66
Facility
$35.57
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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 69100 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
7,584
- Code
- 69100
- Physician work
- 0.79
- Practice expense
- 1.91
- Malpractice
- 0.07
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.79 | × 1.000 | 0.7900 |
| Practice expense | 1.91 | × 0.927 | 1.7706 |
| Malpractice | 0.07 | × 0.486 | 0.0340 |
| Total RVUs | 2.5946 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Indiana$86.66
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.79 | 1 |
| Practice expense | 1.91 | 0.927 |
| Malpractice | 0.07 | 0.486 |
(0.79 × 1 + 1.91 × 0.927 + 0.07 × 0.486) × $33.4009 = $86.66
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.79 | 1 |
| Practice expense | 0.26 | 0.927 |
| Malpractice | 0.07 | 0.486 |
(0.79 × 1 + 0.26 × 0.927 + 0.07 × 0.486) × $33.4009 = $35.57
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.
69100 billing questions
How is this different from 69105?
69100 is for tissue sampled from the visible external ear, such as the pinna. Use 69105 when the biopsy site is in the external auditory canal.
Can the pathology examination be billed separately?
The biopsy code represents tissue acquisition. A separately performed pathology examination may be reported by the responsible laboratory.
Should modifier 50 be used when both ears are biopsied?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
What happens when another procedure is performed in the same session?
The highest-valued procedure is paid in full; other procedures are subject to the standard multiple-procedure reduction. Same-day preoperative and postoperative care is included in the 0-day global period.
What documentation supports reporting this code?
Record the lesion, the precise external-ear site sampled, the reason for tissue diagnosis, and the biopsy performed. The documented site should distinguish the auricle or pinna from the ear canal.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.
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.
7,58169005,,Drg xtrnl ear absc/hem comp,A,,2.11,4.22,,1.94,,0.33,6.66,4.38,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,58269020,,Drg xtrnl aud canal abscess,A,,1.49,5.27,,2.28,,0.21,6.97,3.98,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,58369090,,Ear piercing,N,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
7,58469100,,Biopsy of external ear,A,,0.79,1.91,,0.26,,0.07,2.77,1.12,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,58569105,,Biopsy of external ear canal,A,,0.83,3.37,,0.78,,0.11,4.31,1.72,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,58669110,,Remove external ear partial,A,,3.44,10.11,,5.06,,0.50,14.05,9.00,0,090,0.07,0.79,0.14,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,58769120,,Removal of external ear,A,,4.04,6.19,NA,6.19,,0.57,10.80,10.80,0,090,0.07,0.79,0.14,2,0,1,0,0,9,,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