Billing code 69100: Ear biopsyMedicare rate & RVUs in Texas
Reports tissue sampling of a lesion on the visible external ear, such as the pinna, for histologic diagnosis rather than ear-canal biopsy.
Medicare pays $86.61–$96.01 for 69100 in the office in Texas, from Beaumont to Austin. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 69100 covers
This service obtains tissue from the visible external ear, such as the auricle or pinna, when a lesion requires histologic diagnosis. Otolaryngologists and dermatologists commonly perform it in an office or procedure room. The sampled structure distinguishes this code from a biopsy of the external auditory canal: a lesion on the pinna is the relevant site, not a lesion deeper in the canal.
Choose the code according to the biopsy site and service performed. Document the exact ear subsite, lesion, reason for sampling, and procedure performed. A 0-day global period includes same-day preoperative and postoperative care. 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% reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
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.
Where 69100 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$86.61 to $96.01
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | $96.01 | $37.70 |
| Beaumont | $86.61 | $36.46 |
| Brazoria | $91.64 | $37.03 |
| Dallas | $92.17 | $37.28 |
| Fort Worth | $91.56 | $37.22 |
| Galveston | $91.88 | $37.16 |
| Houston | $93.16 | $38.44 |
| Rest Of Texas | $89.04 | $36.74 |
How the 69100 rate is calculated
Each of 69100’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 69100
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.79Practice expense 1.91Malpractice 0.07
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 69100
The CMS indicators that decide how 69100 is paid alongside other services.
CMS payment indicators · 69100
Ear biopsy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
69100 without 51 · national office
$92.52
Ear biopsy
69100-51 · Second procedure: 50%
$46.26
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
69100 compared with similar codes
Compare codes
69100 vs 69105 vs 69110 vs 69140: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 69105Ear canal biopsy
- Choose 69100 for biopsy of the visible external ear, such as the pinna; choose 69105 when the sampled tissue is in the external auditory canal.
- 69110Auricular excision
- 69100 reports diagnostic tissue sampling. 69110 describes partial external-ear removal when the service is excision rather than biopsy.
- 69140Ear canal excision
- 69140 is for removal of a lesion in the ear canal. 69100 is for biopsy of the visible external ear.
69100 billing questions
How is this different from 69105?
69100 is for tissue sampled from the visible external ear, such as the pinna. Use 69105 when the biopsy site is in the external auditory canal.
Can the pathology examination be billed separately?
The biopsy code represents tissue acquisition. A separately performed pathology examination may be reported by the responsible laboratory.
Should modifier 50 be used when both ears are biopsied?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
What happens when another procedure is performed in the same session?
The highest-valued procedure is paid in full; other procedures are subject to the standard multiple-procedure reduction. Same-day preoperative and postoperative care is included in the 0-day global period.
What documentation supports reporting this code?
Record the lesion, the precise external-ear site sampled, the reason for tissue diagnosis, and the biopsy performed. The documented site should distinguish the auricle or pinna from the ear canal.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service. 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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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