Surgical excision of a chest wall tumor requiring removal of one or more ribs as part of the resection.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $1,111.58
- Total RVUs
- 33.28
- Global, days
- 90
- Region
- Other
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 5 cited references ↓
- Operative note must explicitly state that one or more ribs were excised — not just mobilized or retracted
- Pathology report or intraoperative findings confirming tumor location within or involving the chest wall
- Tumor size, depth, and relationship to adjacent bony and soft tissue structures
- Margin status documentation (gross or final pathologic margins) to support medical necessity and completeness of resection
- If reconstruction was performed at the same session, detail the type and extent to determine whether 21601, 21602, or 21603 applies
- Imaging (CT, MRI, or PET) referenced in the note to establish preoperative tumor extent and necessity for rib resection
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 5 cited references ↓
CPT 21601 covers open resection of a tumor arising from or invading the chest wall where rib removal is necessary to achieve adequate margins. Rib involvement is the key differentiator — if no rib is excised, the correct codes are 21555–21557 (soft tissue tumor of neck/thorax). The procedure is performed under general anesthesia in a hospital OR and typically involves a 3–7 day inpatient stay.
The 90-day global period applies. That window covers the day-before visit, the surgery itself, and all routine post-op care through day 90. Separate E/M visits during the global period require modifier 24 (unrelated) or modifier 25 (significant, separately identifiable, same day as a procedure with a minor global). Reconstruction performed at the same session — chest wall stabilization, mesh, or flap coverage — should be evaluated for separate coding depending on operative complexity and payer policy.
This code sits in a family with 21602 (excision with plastic reconstruction, without mediastinal dissection) and 21603 (excision with plastic reconstruction, with mediastinal dissection). If reconstruction was performed, review whether 21602 or 21603 more accurately reflects the operative work before billing 21601.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 17.34 |
| Practice expense RVU | 11.5 |
| Malpractice RVU | 4.44 |
| Total RVU | 33.28 |
| Medicare national rate | $1,111.58 |
| 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 | $1,111.58 |
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 21601 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Operative note fails to document actual rib excision — payers downcode to 21555–21557 when no bony resection is confirmed
- Wrong code selected when reconstruction was performed — 21602 or 21603 may be more appropriate and payers may recode accordingly
- Medical necessity not established — missing imaging or clinical documentation linking tumor extent to need for rib removal
- Global period violations — separate E/M or minor procedure billed without required modifier 24 or 79 during the 90-day global
- Modifier 22 appended without supporting documentation of increased operative time or complexity in the operative note
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01What separates 21601 from 21555–21557?
02When should 21602 or 21603 be used instead of 21601?
03Can modifier 22 be used if the tumor was unusually large or densely adherent?
04Does the 90-day global cover the thoracic surgery team's post-op visits?
05Is 21601 typically performed in an ASC?
06Can modifier 62 (two surgeons) apply to 21601?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
Mira AI Scribe
Mira's AI scribe captures the specific rib levels resected, tumor dimensions, margin assessment, and any reconstruction technique from the surgeon's dictation. This prevents the most common downcode trigger for 21601 — an operative note that describes chest wall work but never explicitly confirms bony rib excision — which leads payers to reassign the claim to the 21555–21557 soft tissue series.
See how Mira captures CPT 21601 documentation