CPT 56605
Global 000 ActiveBiopsy of vulva/perineum
CPT 56605 Billing & Documentation Guide
CPT code 56605 (Biopsy of vulva/perineum) is classified under Surgery (Urinary/Reproductive) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.07, a non-facility practice expense RVU of 1.54, and a malpractice RVU of 0.19, a total non-facility RVU of 2.8 and facility RVU of 1.55. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $95.58, though rates vary from $83.19 to $117.24 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 56605, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 56605 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Endoscopic or minor procedure with related preoperative and postoperative work performed on the same day
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 56605 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 56605
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.07 | 1.07 |
| Practice Expense RVU | 1.54 | 0.29 |
| Malpractice RVU | 0.19 | 0.19 |
| Total RVU | 2.8 | 1.55 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 56605
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $101.32 | $51.92 | $96.12 - $117.24 | 29 |
| Florida | $99.7 | $57.81 | $94.45 - $105.33 | 3 |
| Georgia | $92.46 | $52.63 | $89.19 - $95.73 | 2 |
| Illinois | $97.69 | $57.35 | $92.62 - $102.25 | 4 |
| Michigan | $92.98 | $53.77 | $89.87 - $96.08 | 2 |
| North Carolina | $87.79 | $48.83 | $87.79 - $87.79 | 1 |
| New York | $103.45 | $56.87 | $89.07 - $110.97 | 5 |
| Ohio | $89.1 | $50.98 | $89.1 - $89.1 | 1 |
| Pennsylvania | $93.23 | $52.34 | $88.96 - $97.5 | 2 |
| Texas | $92.47 | $51.37 | $88.44 - $95.85 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 56605
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 56605 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 00940 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | CPT Separate procedure definition |
Frequently Asked Questions, CPT 56605
What does CPT code 56605 mean? +
CPT code 56605 represents: Biopsy of vulva/perineum. It's in the Surgery (Urinary/Reproductive) category with a global period of 000.
What is the Medicare reimbursement for CPT 56605? +
The 2026 Medicare national average non-facility payment for CPT 56605 is $95.58. Rates range from $83.19 to $117.24 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 56605? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 56605? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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