Surgical removal of a subcutaneous soft tissue tumor 3 cm or greater from the neck or anterior thorax, with specimen submission for pathologic analysis.

Verified May 8, 2026 · 6 sources ↓

Medicare: $429.20
Work RVU: 6.33
Global, days: 90
Region: Other

Drawn from CMSAAPCPayerprice

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Lesion size in centimeters, measured at the lesion itself (not including margins), documented in the operative report
Anatomic location specified as neck or anterior thorax, with laterality noted
Confirmation that the lesion is subcutaneous (above the deep fascia) — subfascial excision maps to a different code family
Pathology submission documented; specimen sent for analysis must be noted in the operative report
Medical necessity established via pre-op imaging, clinical notes, or prior biopsy results supporting excision
Operative note must name the surgical approach and describe dissection layers to distinguish subcutaneous from deeper planes

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 24 Unrelated E/M during global 25 Significant separate E/M LT Left side RT Right side 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 21552 covers excision of a subcutaneous soft tissue tumor of the neck or anterior thorax when the lesion measures 3 cm or greater. The surgeon removes the mass from below the skin surface but above the deep fascia, then submits the specimen for pathologic evaluation. Size is measured at the lesion itself — not including margins — and must be documented in the operative note to justify this code over 21555, which covers lesions under 3 cm.

This code carries a 90-day global period. That means the pre-op visit the day before surgery, the procedure itself, and all routine follow-up through day 90 are bundled. Separate E/M visits within that window require modifier 24 (unrelated) or 25 (same-day, significant and separately identifiable). An unplanned return to the OR for a related complication — such as hematoma evacuation — uses modifier 78. An unrelated procedure during the global uses modifier 79.

Site of service matters here. UnitedHealthcare places 21552 on its site-of-service restriction list, limiting payment to ASC or outpatient hospital settings and denying office-based claims. CMS assigns ASC payment indicator G2, meaning it's a non-office-based surgical procedure. Confirm payer-specific site-of-service policies before scheduling in an office setting — appeals on this issue have been upheld by at least one major commercial payer.

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 (6.33) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (12.85) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	6.33
Practice expense RVU	5.02
Malpractice RVU	1.5
Total RVU	12.85
Medicare national rate	$429.20
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	$429.20
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 21552 get rejected.

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

Site-of-service denial when billed from an office setting — multiple payers including UHC restrict this code to ASC or outpatient hospital
Lesion size not documented or measured at under 3 cm, triggering downcoding to 21555
Incorrect body region — lesion located on the posterior neck or back codes to a different CPT family
Missing or mismatched ICD-10 diagnosis code failing to support medical necessity for surgical excision
Specimen not sent to pathology, undermining documentation of surgical intent and diagnosis

Frequently asked questions

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

01What separates 21552 from 21555?

Size. 21552 is for subcutaneous lesions 3 cm or greater; 21555 covers subcutaneous lesions under 3 cm. Both are neck or anterior thorax, subcutaneous. Measure the lesion itself, not the excision margins.

02What separates 21552 from 21554?

Depth. 21552 is subcutaneous (above the fascia). 21554 covers subfascial tumors of the neck or anterior thorax 5 cm or greater. If the operative note describes dissection through or below the deep fascia, 21554 or 21556 applies depending on size.

03Can 21552 be billed from an office setting?

Not with most commercial payers. UHC's site-of-service list restricts this code to ASC or outpatient hospital, and they've upheld denials on appeal for office-billed claims. CMS also designates it a non-office-based surgical procedure. Verify each payer's policy before scheduling in-office.

04Does the 90-day global period apply to wound checks and suture removal?

Yes. Routine post-op visits, dressing changes, and suture removal through day 90 are bundled. Bill separately only for visits unrelated to the surgery (modifier 24) or for treating a complication requiring a return to the OR (modifier 78 if related, 79 if unrelated).

05Is pathology required to bill 21552?

CMS doesn't mandate a pathology report to submit the surgical claim, but payers expect specimen submission to be documented in the operative note. Absence of pathology documentation raises audit risk and can undermine medical necessity if the diagnosis is challenged.

06When is modifier 22 appropriate for 21552?

Use modifier 22 when the work is substantially greater than typical — for example, a lesion with extensive adhesions, involvement of adjacent structures, or unusually prolonged operative time. The operative note must explicitly describe what made the case harder; vague language won't survive audit.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures lesion size in centimeters (at the lesion, not the margin), depth relative to fascia, anatomic location with laterality, specimen disposition, and the surgical approach from dictation. That locks in the size threshold separating 21552 from 21555 and the depth distinction separating it from subfascial codes — the two most common audit flags on soft tissue neck excision claims.

See how Mira captures CPT 21552 documentation