CPT Code 56605 Excision Procedures on the Vulva, Perineum, and Introitus

• CPT Code: 56605
• Short Descriptor: Biopsy of vulva or perineum (separate procedure); 1 lesion
• Long Descriptor: Biopsy of vulva or perineum, single lesion, performed as a separate procedure
• Category: Excision Procedures on the Vulva, Perineum, and Introitus

This CPT code is used when a biopsy is performed on a single lesion in the vulva or perineum. Because it is labeled as a separate procedure, it should be billed independently and not bundled with a larger surgery unless documentation supports medical necessity.

If more than one lesion is biopsied during the same session, you must also report CPT 56606 for each additional lesion. Importantly, 56606 is an add-on code and cannot be billed independently; it must be submitted in conjunction with 56605.

Clinical Purpose / Indications

The main goal of this biopsy is diagnostic, not therapeutic. It allows the provider to obtain tissue for pathology and confirm the presence of benign, premalignant, or malignant conditions.

A biopsy under 56605 is typically performed when:

• A suspicious lesion is identified on the vulva or perineum
• The biopsy is done as a stand-alone procedure
• Only one lesion is sampled
• The intent is diagnosis, not complete removal

Common indications include:

• Vulvar dysplasia
• Suspected vulvar intraepithelial neoplasia (VIN)
• Lichen sclerosus or other inflammatory dermatoses
• Suspicious pigmented lesions
• Non-healing ulcers or growths in the vulvar/perineal area

Coding Guidelines For 56605 CPT Code & Key Points

• 56605 → First lesion only
• 56606 → Each additional lesion (add-on code, not reported alone)
• If the biopsy extends into a complete excision, report the appropriate excision code instead
• Documentation must include:
  • Exact location of lesion(s)
  • Number of lesions biopsied
  • Confirmation that this was a separate procedure
• Modifiers may be required if other surgeries are performed on the same day

Correct ICD-10-CM diagnosis codes should support medical necessity - such as suspicious neoplasm, VIN, or lichen sclerosus.

Separate Procedure Concept

The term “separate procedure” means 56605 is generally considered integral to larger procedures. If the biopsy is performed alongside an excision or vulvectomy, it may not be separately reportable.

• Not separately billable: A vulvar biopsy done immediately before a vulvectomy during the same session
• Separately billable: A vulvar biopsy performed weeks earlier in its own session

Medicare / CMS Reimbursement (2025)

• Work RVU: ~1.10
• Average Medicare non-facility payment: ~$97.35 (regional variation applies)
• Facility payments are generally lower

Payment notes:

• Vulvar/perineal biopsies often reimburse less than other site-specific biopsies
• Multiple surgery reduction rules may apply if reported with other procedures

Documentation Tips

Clear, detailed documentation ensures clean claim submission and audit protection. Include:

• Indication for biopsy (e.g., suspicious pigmented lesion, chronic ulcer)
• Specific site (left labia majora, right labia minora, midline perineum, etc.)
• Number of lesions biopsied
• Technique (punch, scalpel, wedge, etc.)
• Use of local anesthesia
• Statement that this was a diagnostic biopsy and not a therapeutic excision
• Pathology submission confirmation

Example Scenarios For CPT Code 56605 – Vulvar and Perineal Biopsy

• Single Lesion Biopsy
• A gynecologist biopsies one suspicious vulvar lesion under local anesthesia → Report 56605.
• Multiple Lesions
• A patient has three suspicious lesions. The provider biopsies all three → Report 56605 for the first lesion, 56606 × 2 for the additional lesions.
• Biopsy with Excision
• A lesion is biopsied but then completely excised during the same procedure → Report the excision code, not 56605.

Modifiers That May Apply

• Modifier 59: Indicates the biopsy was a distinct service separate from other procedures
• Modifier XS: Distinct service on a separate organ/structure (if payer accepts)
• Modifier 51: May apply for multiple procedures

Key Takeaways

• 56605 = Biopsy of vulva/perineum, single lesion, separate procedure
• 56606 = Add-on code for each additional lesion
• Use only for diagnostic biopsies, not excision procedures
• Ensure documentation supports:
  • Lesion count
  • Site
  • Medical necessity
• Reimbursement is modest, but accurate coding ensures compliance and prevents denials

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