$107.10
Use 57100 for a simple vaginal mucosal biopsy. Use 57105 when the documented sampling is extensive; do not select it solely because multiple fragments were submitted.
On this page
CMS RVU26D · Effective 2026-10-01
57105 Vaginal biopsy Medicare reimbursement rates in Rhode Island
Reports extensive sampling of abnormal vaginal mucosa for histologic assessment, such as broad or multifocal lesions, when the documented biopsy exceeds a simple mucosal biopsy. Compare 57105 office and facility rates across CMS payment localities in Rhode Island.
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 57105 in Rhode Island?
Rhode Island 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
$178.79
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
Facility setting
$137.73
1 of 1 localities have a supported rate.
Payment area: Rhode Island
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.
Gynecologic procedure
About 57105: Extensive vaginal mucosal biopsy
Reports extensive sampling of abnormal vaginal mucosa for histologic assessment, such as broad or multifocal lesions, when the documented biopsy exceeds a simple mucosal biopsy.
An extensive vaginal mucosal biopsy removes tissue from a broad or multifocal abnormal area for histologic evaluation. Gynecologists and gynecologic oncologists may perform it in an office or facility setting when examination identifies suspicious vaginal mucosa, such as persistent lesions or changes concerning for vaginal intraepithelial neoplasia or malignancy. The code reflects the extent of the biopsy service, not simply a stated number of tissue fragments.
Choose 57105 rather than 57100 when the documented biopsy work is extensive. Record the lesion distribution and appearance, sites sampled, and extent of tissue collection. The code has a 10-day global period, so related postoperative visits during that period are included. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Do not append modifier 50 for bilateral vaginal biopsy. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
CMS billing rules for 57105
- 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 not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU1.70 · 32%
- Practice expense (office) RVU3.22 · 61%
- Malpractice RVU0.33 · 6%
349
Medicare services in 2024 · #3867 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.
57105 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
$185.06
57421 describes vaginal colposcopy with biopsy. When the biopsies are part of that colposcopy service, they are included rather than separately reported as 57105.
$247.79
57135 is for excision of a vaginal cyst or tumor. 57105 is for extensive sampling of vaginal mucosa, not removal of a cyst or tumor.
$95.21
56605 applies to biopsy of vulvar or perineal tissue. 57105 applies to vaginal mucosa.
Compare 57105 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
Rhode Island →
Office / nonfacility
$178.79
Facility
$137.73
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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 57105 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
6,436
- Code
- 57105
- Physician work
- 1.70
- Practice expense
- 3.22
- Malpractice
- 0.33
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.70 | × 1.019 | 1.7323 |
| Practice expense | 3.22 | × 1.033 | 3.3263 |
| Malpractice | 0.33 | × 0.892 | 0.2944 |
| Total RVUs | 5.3529 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Rhode Island$178.79
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.7 | 1.019 |
| Practice expense | 3.22 | 1.033 |
| Malpractice | 0.33 | 0.892 |
(1.7 × 1.019 + 3.22 × 1.033 + 0.33 × 0.892) × $33.4009 = $178.79
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.7 | 1.019 |
| Practice expense | 2.03 | 1.033 |
| Malpractice | 0.33 | 0.892 |
(1.7 × 1.019 + 2.03 × 1.033 + 0.33 × 0.892) × $33.4009 = $137.73
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.
57105 billing questions
How does 57105 differ from 57100?
57105 is for extensive vaginal mucosal biopsy work; 57100 describes a simple biopsy. Document the extent and distribution of the sampled abnormal mucosa rather than relying only on the number of tissue fragments.
Can 57105 be reported with vaginal colposcopy and biopsy?
When 57421 is reported for vaginal colposcopy with biopsies, those biopsies are included in that service. Do not separately report 57105 for the same biopsy work.
Should modifier 50 be used for biopsies on both sides of the vagina?
No. The CMS bilateral adjustment does not apply to 57105, and modifier 50 is inappropriate.
Are related postoperative visits included?
Yes. Related postoperative visits during the 10-day global period are included in 57105.
What documentation supports choosing the extensive-biopsy code?
Document the abnormal mucosa's appearance and distribution, the sites sampled, and the extent of tissue collection. The record should show why the service was extensive rather than a simple vaginal mucosal biopsy.
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.
6,43357061,,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
6,43957109,,Vagnc bi total pel lymphadec,A,,27.69,14.54,NA,14.54,,6.42,48.65,48.65,0,090,0.12,0.74,0.14,2,2,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537