$171.16–$189.64
56420 identifies drainage of a Bartholin gland abscess. Choose 56405 for a vulvar or perineal abscess that does not involve that gland.
On this page
CMS RVU26D · Effective 2026-10-01
56405 Abscess drainage Medicare reimbursement rates in Pennsylvania
Reports incision and drainage of an abscess in the vulva or perineum, excluding a Bartholin gland abscess coded to its specific procedure. Compare 56405 office and facility rates across CMS payment localities in Pennsylvania.
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 56405 in Pennsylvania?
Pennsylvania 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
$138.20–$152.15
2 of 2 localities have a supported rate.
Facility setting
$111.52–$121.90
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.
Gynecologic procedure
About 56405: Vulvar or perineal abscess drainage
Reports incision and drainage of an abscess in the vulva or perineum, excluding a Bartholin gland abscess coded to its specific procedure.
A clinician incises and drains a localized collection of pus in the vulvar or perineal tissues. The service may be performed by a gynecologist, family physician, or other qualified clinician in an office or facility setting. A vulvar soft-tissue abscess is an example; an abscess of the Bartholin gland has its own code. The documented site should distinguish the treated abscess from a Bartholin gland abscess and from an abscess elsewhere on the skin.
Report 56405 when the abscess is in the vulva or perineum and the service is incision and drainage. The record should identify the anatomic location and describe the drainage procedure. Related postoperative visits during the 10-day global period are included. When multiple procedures occur 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. Medicare does not pay an assistant at surgery; co-surgeons are permitted, while team surgery is not permitted.
CMS billing rules for 56405
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days are 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 permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU1.45 · 33%
- Practice expense (office) RVU2.66 · 61%
- Malpractice RVU0.26 · 6%
4.9K
Medicare services in 2024 · #1874 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.
56405 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
$121.43–$133.61
10060 is the general code for incision and drainage of a simple or single abscess. 56405 identifies the vulvar or perineal site.
$208.91–$228.98
10061 is the general code for complicated or multiple abscesses. 56405 is specific to a vulvar or perineal abscess.
No office rate
56440 describes marsupialization of a Bartholin gland cyst, a different procedure from draining a vulvar or perineal abscess.
Compare 56405 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
Metropolitan Philadelphia →
Office / nonfacility
$152.15
Facility
$121.90
Rest Of Pennsylvania →
Office / nonfacility
$138.20
Facility
$111.52
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56405 billing questions
When should 56405 be used instead of 56420?
Use 56405 for an abscess in vulvar or perineal tissue. Use 56420 when the abscess involves the Bartholin gland.
What documentation supports 56405?
Document the abscess location in the vulva or perineum and the incision-and-drainage service performed. Clarify whether the Bartholin gland is involved.
Can modifier 50 be reported?
No. The descriptor and anatomy make modifier 50 inappropriate for this code.
Are related postoperative visits separately reported?
Related postoperative visits during the 10-day global period are included in the procedure.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures are subject to the standard multiple procedure reduction.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeons are permitted, but team surgery is not.
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.
6,40055920,,Place needles pelvic for rt,A,,8.10,2.71,NA,2.71,,0.69,11.50,11.50,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,40155970,,Sex transformation m to f,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,YYY,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
6,40255980,,Sex transformation f to m,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,YYY,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
6,40356405,,I&d vulva/perineal abscess,A,,1.45,2.66,,1.79,,0.26,4.37,3.50,0,010,0.10,0.80,0.10,2,0,1,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,40456420,,I&d bartholins gland abscess,A,,1.40,3.81,,1.36,,0.24,5.45,3.00,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,40556440,,Mrsplzatn brthlns glnd cst,A,,2.82,1.60,NA,1.60,,0.48,4.90,4.90,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,40656441,,Lysis of labial adhesions,A,,1.97,3.15,,1.90,,0.34,5.46,4.21,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00