CPT 57100
Global 000 ActiveBiopsy vaginal mucosa simple
CPT 57100 Billing & Documentation Guide
CPT code 57100 (Biopsy vaginal mucosa simple) is classified under Surgery (Urinary/Reproductive) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.17, a non-facility practice expense RVU of 1.76, and a malpractice RVU of 0.22, a total non-facility RVU of 3.15 and facility RVU of 1.75. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $107.52, though rates vary from $93.36 to $132.09 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 57100, 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 57100 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 2 units of 57100 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 57100
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.17 | 1.17 |
| Practice Expense RVU | 1.76 | 0.36 |
| Malpractice RVU | 0.22 | 0.22 |
| Total RVU | 3.15 | 1.75 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 57100
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 | $114.02 | $58.69 | $108.11 - $132.09 | 29 |
| Florida | $112.36 | $65.45 | $106.32 - $118.86 | 3 |
| Georgia | $104.01 | $59.4 | $100.27 - $107.75 | 2 |
| Illinois | $110.06 | $64.88 | $104.24 - $115.3 | 4 |
| Michigan | $104.63 | $60.71 | $101.05 - $108.2 | 2 |
| North Carolina | $98.62 | $54.99 | $98.62 - $98.62 | 1 |
| New York | $116.5 | $64.34 | $100.09 - $125.12 | 5 |
| Ohio | $100.16 | $57.46 | $100.16 - $100.16 | 1 |
| Pennsylvania | $104.87 | $59.07 | $99.99 - $109.74 | 2 |
| Texas | $103.99 | $57.96 | $99.4 - $107.88 | 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 57100
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 57100 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 57100
What does CPT code 57100 mean? +
CPT code 57100 represents: Biopsy vaginal mucosa simple. It's in the Surgery (Urinary/Reproductive) category with a global period of 000.
What is the Medicare reimbursement for CPT 57100? +
The 2026 Medicare national average non-facility payment for CPT 57100 is $107.52. Rates range from $93.36 to $132.09 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 57100? +
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 57100? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 2, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team