$94.87
Choose 69105 for tissue sampled from inside the external auditory canal; choose 69100 for a biopsy of the external ear, such as the pinna.
On this page
CMS RVU26D · Effective 2026-10-01
69105 Ear canal biopsy Medicare reimbursement rates in Rhode Island
Reports tissue sampling of a suspicious lesion in the external auditory canal when microscopic examination is needed to establish a diagnosis. Compare 69105 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 69105 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
$147.80
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
Facility setting
$58.44
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.
Otolaryngology procedure
About 69105: External auditory canal lesion biopsy
Reports tissue sampling of a suspicious lesion in the external auditory canal when microscopic examination is needed to establish a diagnosis.
An otolaryngologist typically performs this biopsy when tissue from a lesion in the external auditory canal is needed for diagnosis, such as evaluation of a growth or abnormal area in the ear canal. The canal extends inward from the ear opening toward the tympanic membrane; a biopsy of the visible outer ear instead is a different service. The procedure may be performed in an office or facility, depending on the lesion and clinical circumstances.
Choose this code when the service is tissue sampling for diagnosis, rather than definitive removal of the canal lesion. Document the canal site, the abnormal finding, the reason for sampling, and the specimen obtained. A separately performed pathology interpretation may be reported by the responsible pathologist. This is a 0-day global procedure, so same-day preoperative and postoperative care is included. For bilateral reporting with modifier 50, CMS pays 150%. When multiple procedures occur in one session, the highest-valued is paid in full and others at 50%. Assistant-at-surgery payment is restricted; co-surgeons and team surgery are not permitted.
CMS billing rules for 69105
- 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 procedure with modifier 50 is paid at 150%.
- 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 RVU0.83 · 19%
- Practice expense (office) RVU3.37 · 78%
- Malpractice RVU0.11 · 3%
1.7K
Medicare services in 2024 · #2569 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.
69105 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
No office rate
69105 represents diagnostic tissue sampling. Consider 69140 when the service is excision of an external auditory canal lesion.
$415.11
69105 is for biopsy sampling in the canal; 69145 is an excision code for removal of a canal lesion.
Compare 69105 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
$147.80
Facility
$58.44
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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 69105 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
7,585
- Code
- 69105
- Physician work
- 0.83
- Practice expense
- 3.37
- Malpractice
- 0.11
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.83 | × 1.019 | 0.8458 |
| Practice expense | 3.37 | × 1.033 | 3.4812 |
| Malpractice | 0.11 | × 0.892 | 0.0981 |
| Total RVUs | 4.4251 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Rhode Island$147.80
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.83 | 1.019 |
| Practice expense | 3.37 | 1.033 |
| Malpractice | 0.11 | 0.892 |
(0.83 × 1.019 + 3.37 × 1.033 + 0.11 × 0.892) × $33.4009 = $147.80
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.83 | 1.019 |
| Practice expense | 0.78 | 1.033 |
| Malpractice | 0.11 | 0.892 |
(0.83 × 1.019 + 0.78 × 1.033 + 0.11 × 0.892) × $33.4009 = $58.44
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.
69105 billing questions
How is this different from 69100?
This code is for a biopsy in the external auditory canal. Code 69100 is for a biopsy of the external ear, such as the pinna.
When should an excision code be considered instead?
Use a canal lesion excision code when the service is removal rather than diagnostic tissue sampling. Codes 69140 and 69145 are the nearby canal-lesion excision choices.
Is the pathology examination included?
This code describes obtaining the tissue specimen. A separately performed pathology interpretation may be reported by the responsible pathologist.
How is bilateral biopsy paid?
For a bilateral procedure reported with modifier 50, CMS pays 150% under the stated bilateral rule.
What happens when another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the others are paid at 50%. Same-day preoperative and postoperative care for this biopsy is included in its 0-day global period.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment is restricted for this code. 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.
7,58269020,,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
7,58869140,,Remove ear canal lesion(s),A,,7.94,16.13,NA,16.13,,1.16,25.23,25.23,0,090,0.07,0.79,0.14,2,1,0,0,0,9,,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