$162.48
57100 represents simple vaginal mucosal sampling. 57105 is for an extensive biopsy, so the documented extent determines the choice.
On this page
CMS RVU26D · Effective 2026-10-01
57100 Vaginal biopsy Medicare reimbursement rates in Kentucky
Report this service for a simple biopsy of vaginal mucosa, such as sampling a localized abnormal area for diagnostic evaluation. Compare 57100 office and facility rates across CMS payment localities in Kentucky.
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 57100 in Kentucky?
Kentucky 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
$98.06
1 of 1 localities have a supported rate.
Payment area: Kentucky
One mapped payment locality.
Facility setting
$56.49
1 of 1 localities have a supported rate.
Payment area: Kentucky
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 57100: Simple vaginal mucosal biopsy
Report this service for a simple biopsy of vaginal mucosa, such as sampling a localized abnormal area for diagnostic evaluation.
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.
CMS billing rules for 57100
- 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 RVU1.17 · 37%
- Practice expense (office) RVU1.76 · 56%
- Malpractice RVU0.22 · 7%
4.6K
Medicare services in 2024 · #1937 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.
57100 compared with similar codes
Office rates for Kentucky, from the same CMS release.
$226.32
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.
$170.16
57421 is vaginal colposcopy with biopsy when performed. Do not add 57100 for a biopsy included in that colposcopy service.
Compare 57100 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
Kentucky →
Office / nonfacility
$98.06
Facility
$56.49
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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 57100 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
6,435
- Code
- 57100
- Physician work
- 1.17
- Practice expense
- 1.76
- Malpractice
- 0.22
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.17 | × 1.000 | 1.1700 |
| Practice expense | 1.76 | × 0.889 | 1.5646 |
| Malpractice | 0.22 | × 0.915 | 0.2013 |
| Total RVUs | 2.9359 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Kentucky$98.06
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.17 | 1 |
| Practice expense | 1.76 | 0.889 |
| Malpractice | 0.22 | 0.915 |
(1.17 × 1 + 1.76 × 0.889 + 0.22 × 0.915) × $33.4009 = $98.06
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.17 | 1 |
| Practice expense | 0.36 | 0.889 |
| Malpractice | 0.22 | 0.915 |
(1.17 × 1 + 0.36 × 0.889 + 0.22 × 0.915) × $33.4009 = $56.49
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.
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 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.
6,43257023,,I&d vaginal hematoma non-ob,A,,5.05,2.54,NA,2.54,,0.89,8.48,8.48,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,43357061,,Destruction vag lesions smpl,A,,1.27,3.39,,1.67,,0.22,4.88,3.16,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,43457065,,Destruction vag lesion xtnsv,A,,2.59,4.20,,1.93,,0.45,7.24,4.97,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,43557100,,Biopsy vaginal mucosa simple,A,,1.17,1.76,,0.36,,0.22,3.15,1.75,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,43657105,,Biopsy vaginal mucosa xtnsv,A,,1.70,3.22,,2.03,,0.33,5.25,4.06,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,43757106,,Vagnc prtl rmvl vag wall,A,,7.31,6.08,NA,6.08,,1.35,14.74,14.74,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,43857107,,Vagnc compl rmvl paravag tis,A,,23.95,10.91,NA,10.91,,4.69,39.55,39.55,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631