Surgical removal of a subcutaneous soft tissue tumor or mass in the neck or anterior thorax measuring less than 3 cm.

Verified May 8, 2026 · 5 sources ↓

Medicare: $462.60
Work RVU: 3.86
Global, days: 90
Region: Other

Drawn from CMSAAPCGenhealth

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Lesion size documented in centimeters — measured specimen size, not pre-op imaging estimate
Anatomic location specified as neck or anterior thorax, subcutaneous depth confirmed
Operative note describes dissection technique, depth of excision, and confirmation of complete removal
Pathology requisition and final pathology report correlating specimen to the excised lesion
Anesthesia type documented (local, MAC, or general)
Indication for excision — symptom-based or diagnostic rationale stated in the medical record

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 51 Multiple procedures 52 Reduced services 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 5 cited references ↓

CPT 21555 covers open excision of a subcutaneous soft tissue tumor located in the neck or anterior thorax when the lesion measures less than 3 cm. The surgeon makes a direct incision over or near the mass, dissects it free from surrounding tissue, confirms complete removal, controls hemostasis, and closes the wound in layers. The specimen is typically sent for pathologic analysis. Local anesthesia with or without sedation is standard; general anesthesia is used selectively.

The 90-day global period means all routine postoperative care — wound checks, suture removal, and related office visits — is bundled into the surgical payment through day 90. Any E/M service for an unrelated problem during that window needs modifier 24. A significant, separately identifiable E/M on the day of surgery requires modifier 25 appended to the E/M code.

Size matters for code selection. If the lesion is 3 cm or larger, 21556 applies. Confirm the final pathology measurement drives code selection, not the pre-op estimate. Multiple lesions excised at the same session should be coded individually; modifier 51 applies to the secondary procedure(s).

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 (3.86) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (13.85) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	3.86
Practice expense RVU	9.17
Malpractice RVU	0.82
Total RVU	13.85
Medicare national rate	$462.60
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	$462.60
HOPD (APC 5072) Hospital outpatient department	$1,687.37
ASC (PI G2) Ambulatory surgical center (freestanding)	$742.04

Common denial reasons

The recurring reasons claims for CPT 21555 get rejected.

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

Code selected based on pre-op imaging size rather than final excised specimen measurement, triggering upcoding or downcoding disputes
Missing or mismatched pathology report — payers audit specimen submission when billing an excision code
E/M billed same-day without modifier 25, bundled into the surgical payment
Incorrect body region — lesions on the posterior neck or chest wall may not satisfy the anterior thorax descriptor
Global period violation — post-op follow-up billed without modifier 24 when the problem is related to the surgery

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What's the difference between 21555 and 21556?

Size threshold. 21555 is for subcutaneous soft tissue tumors of the neck or anterior thorax under 3 cm. 21556 applies when the lesion is 3 cm or larger. Use the final excised specimen size — not the pre-op MRI or ultrasound measurement — to select the correct code.

02Can I bill 21555 for a lipoma in the neck?

Yes. Lipomas are the most common soft tissue tumor coded to 21555, provided the lesion is subcutaneous, located in the neck or anterior thorax, and measures less than 3 cm on final specimen measurement. The pathology report should confirm the diagnosis.

03How do I bill multiple lesions excised at the same session?

Report each lesion separately with its own CPT code based on individual size. Append modifier 51 to the secondary and subsequent procedures. Do not combine lesion measurements to push a case into a higher-complexity code.

04Is a same-day E/M separately billable?

Only if the E/M is significant and separately identifiable from the decision to excise. Append modifier 25 to the E/M code. If the visit was solely to evaluate the lesion being removed that day, it's bundled.

05What global period applies, and what does it cover?

21555 carries a 90-day global period. It bundles the day-before pre-op visit, the surgery itself, and all routine post-op care through day 90 — wound checks, dressing changes, and suture removal. Bill unrelated problems during the global period with modifier 24 on the E/M.

06Does the lesion need to be sent to pathology?

Clinically, yes in almost all cases — payers expect a pathology report for an excised mass. Operative notes that lack a specimen disposition are an audit flag. If the specimen was not sent, document the clinical rationale in the operative note.

07Is there a site-of-service payment difference between HOPD and ASC?

Yes, and it is substantial. CMS pays significantly more for 21555 in the hospital outpatient department than in an ASC. See the Site of Service comparison table on this page for the 2026 payment figures.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the lesion's measured size in centimeters from the operative dictation, confirms 'subcutaneous' depth and 'neck or anterior thorax' anatomic location, and flags the pathology specimen ID. This prevents the most common 21555 audit trigger: a post-op note that records anatomic location vaguely or omits final specimen size, leaving coders to guess between 21555 and 21556.

See how Mira captures CPT 21555 documentation