CPT 57421
Global 000 ActiveExam/biopsy of vag w/scope
CPT 57421 Billing & Documentation Guide
CPT code 57421 (Exam/biopsy of vag w/scope) is classified under Surgery (Urinary/Reproductive) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2.15, a non-facility practice expense RVU of 2.88, and a malpractice RVU of 0.42, a total non-facility RVU of 5.45 and facility RVU of 3.27. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $185.68, though rates vary from $161.67 to $225.94 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 57421, 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 57421 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 57421 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 57421
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.15 | 2.15 |
| Practice Expense RVU | 2.88 | 0.7 |
| Malpractice RVU | 0.42 | 0.42 |
| Total RVU | 5.45 | 3.27 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 57421
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 | $195.82 | $109.66 | $185.98 - $225.94 | 29 |
| Florida | $195.64 | $122.58 | $184.86 - $207.43 | 3 |
| Georgia | $180.48 | $111.01 | $174.34 - $186.61 | 2 |
| Illinois | $191.82 | $121.46 | $181.56 - $201.19 | 4 |
| Michigan | $181.89 | $113.52 | $175.48 - $188.29 | 2 |
| North Carolina | $170.53 | $102.59 | $170.53 - $170.53 | 1 |
| New York | $201.6 | $120.37 | $173.06 - $216.83 | 5 |
| Ohio | $173.78 | $107.3 | $173.78 - $173.78 | 1 |
| Pennsylvania | $181.68 | $110.36 | $173.38 - $189.98 | 2 |
| Texas | $179.94 | $108.26 | $172.38 - $187.21 | 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 57421
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 57421 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0031T | Column 1 (primary), can be billed with modifier | Yes | More extensive procedure |
| 0032T | Column 1 (primary), can be billed with modifier | Yes | More extensive procedure |
| 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 |
Frequently Asked Questions, CPT 57421
What does CPT code 57421 mean? +
CPT code 57421 represents: Exam/biopsy of vag w/scope. It's in the Surgery (Urinary/Reproductive) category with a global period of 000.
What is the Medicare reimbursement for CPT 57421? +
The 2026 Medicare national average non-facility payment for CPT 57421 is $185.68. Rates range from $161.67 to $225.94 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 57421? +
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 57421? +
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 May 31, 2026.
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