Radical resection of a soft tissue tumor of the face or scalp measuring less than 2 cm, performed with wide margins consistent with malignant or suspected malignant disease.

Verified May 8, 2026 · 6 sources ↓

Medicare: $639.63
Work RVU: 9.64
Global, days: 90
Region: Other

Drawn from CMSMdclarityAAPCFindacodePayerprice

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 6 cited references ↓

Preoperative note documenting clinical suspicion of malignancy or confirmed sarcoma diagnosis justifying radical resection rather than simple excision
Operative report specifying tumor location on face or scalp, measured size confirmed intraoperatively as less than 2 cm
Description of resection margins and extent of tissue removed to support 'radical' characterization distinct from shave or simple excision
Pathology report or pending pathology order linked to the operative encounter to substantiate malignancy indication
Documentation of any involvement of adjacent structures, nerve preservation, or reconstructive steps performed in the same session

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 25 Significant separate E/M 51 Multiple procedures 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 21015 describes a radical resection — not a simple excision — of a soft tissue tumor (e.g., sarcoma) located on the face or scalp when the lesion is under 2 cm. Radical resection implies wide-margin removal designed to address known or suspected malignancy, distinguishing this code from benign excision codes. The approach requires removal of the tumor along with a surrounding cuff of normal tissue to reduce local recurrence risk.

The 90-day global period covers the operative session, the day-before visit, and all routine postoperative care through day 90. Any separately identifiable E/M on the day of surgery requires modifier 25. Unplanned return to the OR for a related complication during the global window requires modifier 78; an unrelated procedure in that same window requires modifier 79.

This code is most frequently billed by general surgery and plastic and reconstructive surgery, with ophthalmology appearing in CMS utilization data for periorbital lesions. Place of service matters: HOPD and ASC reimbursement differ significantly — see the Site of Service comparison on this page. Payer-side, the key documentation battle is establishing medical necessity for radical (rather than simple) resection, which hinges on pathology suspicion documented preoperatively.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (9.64) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (19.15) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	9.64
Practice expense RVU	7.82
Malpractice RVU	1.69
Total RVU	19.15
Medicare national rate	$639.63
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$639.63
HOPD (APC 5073) Hospital outpatient department	$2,967.63
ASC (PI G2) Ambulatory surgical center (freestanding)	$1,248.36

Common denial reasons

The recurring reasons claims for CPT 21015 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Operative note uses generic language like 'excision of lesion' without explicitly describing radical wide-margin resection technique or malignancy rationale
Size not documented intraoperatively — relying solely on imaging measurement without confirming surgical specimen size
Bundling denial when closure or reconstruction coded separately without supporting documentation that the repair was distinct and beyond routine wound closure
Lack of pathology or biopsy documentation to justify radical approach over a benign-excision code, triggering medical necessity denial

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What separates CPT 21015 from a standard excision code like 11640–11646?

21015 is a radical resection — wide-margin removal intended for known or suspected malignant soft tissue tumors such as sarcoma. Codes 11640–11646 cover malignant skin lesion excisions. Use 21015 when the resection goes into deep soft tissue with intent to achieve oncologic margins, not just skin-level removal.

02Does the 90-day global include postoperative wound checks and suture removal?

Yes. The 90-day global covers the day-before visit, the operative day, and all routine postop care through day 90 — including wound checks, dressing changes, and suture removal. Bill modifier 24 for E/M visits unrelated to the surgery, and modifier 79 for unrelated procedures during the global window.

03Can CPT 21015 and a reconstructive flap code be billed together on the same day?

Yes, if the reconstructive procedure is separately documented as distinct from routine wound closure. Modifier 59 or XS supports the separate billing. The operative note must make clear that closure required a distinct technique beyond what is inherent to the resection.

04When is modifier 22 appropriate with 21015?

Use modifier 22 when the work substantially exceeded the typical procedure — for example, tumor adherence to underlying facial nerve branches, unusually complex anatomy, or significantly prolonged operative time. Attach a cover letter quantifying the additional work; payers rarely accept modifier 22 without supporting documentation.

05Is a bilateral modifier applicable for face or scalp tumors?

Modifier 50 applies if radical resections were performed on contralateral sites during the same session. This is uncommon for a single tumor but would apply if, for example, synchronous lesions on both sides of the face were each radically resected. Document each site separately in the operative report.

06What ICD-10 diagnoses support medical necessity for CPT 21015?

Soft tissue sarcoma of the head (C49.0), malignant neoplasm of connective and soft tissue of the face, and analogous malignant diagnoses are the primary supports. A suspicious or unspecified mass code alone may not satisfy payer medical necessity criteria for a radical approach — preoperative biopsy or imaging findings should be reflected in the diagnosis coding.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira Scribe

Mira's AI scribe captures the surgeon's dictated tumor size, anatomic location on the face or scalp, resection margin intent, and the clinical basis for radical rather than simple excision. It flags if the operative note omits the word 'radical' or fails to document preoperative malignancy suspicion — the two most common triggers for downcoding to a benign excision code on audit.

See how Mira captures CPT 21015 documentation