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See a sample rate comparisonCPT 56821 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Scope Exam Of Genitals, An Exam Of A Womans Genitals Using A Scope (Colposcopy). The Procedure May Include Removing A Sample Of Tissue For Testing (Biopsy).
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Female Genital System |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 51 - Multiple procedures 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 56821 |
| Medicaid Fee Schedule | View Medicaid rates for 56821 |
National average reimbursement for CPT 56821 by major payers:
$201.25
$206.40
$219.90
$192.61
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CPT 56821
5 of 25 sample ratesHigher to lower in this preview
Inova Loudoun Ambulatory Surgery
$932.00Published rateRiverside Park Surgicenter LLC
$566.00Published rateDoctors Gi Partnership Ltd, Hf Surgery Center At Babcock
Doctors Gi Partnership Ltd
$314.00Published rateThe Regents Of The University Of California, Ucla Dept Of Medicine
$186.00Published rateComprehensive Pain Center For Surgery, Fountains Specialty Surgical Center
Comprehensive Pain Center For Surgery
$101.00Published rate
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See a sample payer proposalCPT 56821 vs. Other Surgical Procedures on the Female Genital System Codes
The CPT 56821 code is part of the Surgery services used for Surgical Procedures on the Female Genital System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 56821 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 56820-CPT | Low | Scope Exam Of Genitals, An Exam Of A Womans Genitals Using A Scope (Colposcopy). The Procedure May Include Removing A Sample Of Tissue For Testing (Biopsy). |
| 56821-CPT | Moderate | Scope Exam Of Genitals, An Exam Of A Womans Genitals Using A Scope (Colposcopy). The Procedure May Include Removing A Sample Of Tissue For Testing (Biopsy). |
| 57100-CPT | Low | Biopsy Of Vagina, A Procedure To Take A Sample Of Tissue Or Cells From The Vagina For Testing (Biopsy). The Procedure May Require Stitches. |
| 57105-CPT | Moderate | Biopsy Of Vagina, A Procedure To Take A Sample Of Tissue Or Cells From The Vagina For Testing (Biopsy). The Procedure May Require Stitches. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 56821. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 56821 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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