$158.89–$165.51
Both describe colposcopic evaluation of the vulva. Choose 56821 when biopsy is performed; 56820 is for examination without biopsy.
On this page
CMS RVU26D · Effective 2026-10-01
56820 Vulvar colposcopy Medicare reimbursement rates in Maine
A clinician examines vulvar tissue under magnification to assess visible abnormalities when a diagnostic colposcopic evaluation is needed and no biopsy is taken. Compare 56820 office and facility rates across CMS payment localities in Maine.
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 56820 in Maine?
Maine 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
$118.91–$123.97
2 of 2 localities have a supported rate.
Facility setting
$70.66–$72.00
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 56820: Magnified vulvar examination without biopsy
A clinician examines vulvar tissue under magnification to assess visible abnormalities when a diagnostic colposcopic evaluation is needed and no biopsy is taken.
This service is a focused, magnified examination of the vulvar skin and mucosa, typically performed by a gynecologist or another qualified clinician in an office or outpatient setting. It may be used to assess a visible lesion, persistent color or texture change, or another finding that warrants closer evaluation. The examination helps characterize the affected area; tissue sampling is not part of this code.
Report it when the documented service is vulvar colposcopy without biopsy. The record should identify the clinical reason for the examination, the area examined, and the findings; if a biopsy is performed as part of the colposcopic service, use the biopsy-inclusive sibling code 56821 instead. This minor procedure has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate; assistant-at-surgery payment is restricted, and co-surgeon and team-surgery reporting are not permitted.
CMS billing rules for 56820
- 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 RVU1.46 · 38%
- Practice expense (office) RVU2.10 · 55%
- Malpractice RVU0.27 · 7%
6.3K
Medicare services in 2024 · #1729 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.
56820 compared with similar codes
Office rates for Maine, from the same CMS release.
$127.79–$133.23
This code is for colposcopic examination of the vagina rather than the vulva. Select based on the anatomic site evaluated.
$169.04–$175.99
This code describes vaginal colposcopy with biopsy. It differs from 56820 in both the site examined and the inclusion of biopsy.
Compare 56820 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
Rest Of Maine →
Office / nonfacility
$118.91
Facility
$70.66
Southern Maine →
Office / nonfacility
$123.97
Facility
$72.00
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56820 billing questions
When should 56820 be used instead of 56821?
Use 56820 for vulvar colposcopic examination without biopsy. When tissue is sampled during the examination, report 56821, the biopsy-inclusive sibling.
Can a separate vulvar biopsy code be reported with 56820?
56820 describes the colposcopic examination without biopsy. If biopsy is performed during that examination, use 56821 rather than reporting 56820 as the no-biopsy service.
What documentation supports 56820?
Document the reason for examining the vulva, the area evaluated, the colposcopic findings, and whether tissue was sampled.
Does the service have a global period?
It has a 0-day global period. Same-day preoperative and postoperative care is included.
How does the multiple-procedure rule affect payment?
For procedures performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction.
Can modifier 50 or an assistant-at-surgery claim be used?
Modifier 50 is inappropriate for this service. Assistant-at-surgery payment is restricted, and 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.
6,42356800,,Plastic repair introitus,A,,3.83,2.31,NA,2.31,,0.66,6.80,6.80,0,010,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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