Excision of a chest wall tumor involving one or more ribs, with plastic reconstruction of the chest wall defect, without mediastinal lymphadenectomy.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,529.09
Total RVUs: 45.78
Global, days: 90
Region: Other

Drawn from CMSAAPCFindacodeMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify which rib(s) were resected, including number and laterality
Document extent of tumor involvement — rib cortex invasion, soft tissue margins, depth
Describe the reconstruction method by name: myocutaneous flap, prosthetic mesh, bone graft, or combination
Confirm absence of mediastinal lymphadenectomy explicitly in the operative note to support 21602 over 21603
Record tumor size and pathologic diagnosis or intraoperative frozen section results
Document the surgical approach and any co-surgeon roles if modifier 62 is appended

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 59 Distinct service 62 Co-surgeons 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 21602 covers en bloc removal of a chest wall tumor that invades or involves the rib(s), combined with plastic reconstruction of the resulting defect — typically using myocutaneous flaps, bone grafts, or prosthetic mesh. The absence of mediastinal lymphadenectomy is the defining distinction from 21603, which includes nodal dissection. This is a high-complexity, high-RVU procedure most commonly performed in the inpatient or on-campus outpatient hospital setting.

The 90-day global period covers all routine post-op care from the day before surgery through day 90. Any E/M visit or procedure in that window for a new or unrelated condition requires modifier 24 or 79, respectively. Reconstruction is bundled into this code — do not separately report flap or graft codes when the reconstruction is integral to the chest wall closure performed at the same operative session.

Code selection hinges on two criteria: rib involvement and reconstruction. If the tumor is excised from soft tissue of the anterior thorax without rib involvement, consider 21552–21558 based on depth and size. If ribs are partially excised without reconstruction, 21600 applies. If lymphadenectomy is added, step up to 21603.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	21.64
Practice expense RVU	18.83
Malpractice RVU	5.31
Total RVU	45.78
Medicare national rate	$1,529.09
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	$1,529.09
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,682.29

Common denial reasons

The recurring reasons claims for CPT 21602 get rejected.

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

Upcoding to 21603 denied when lymphadenectomy is not documented in the operative report
Reconstruction codes billed separately when the flap or graft closure is integral to 21602 and already bundled
Soft-tissue-only excision billed as 21602 when operative note lacks documentation of rib involvement
Modifier 62 denied due to absence of distinct operative roles documented for each co-surgeon
Global period violations — post-op E/M visits billed without modifier 24 during the 90-day window

Frequently asked questions

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

01What is the difference between 21602 and 21603?

21602 is excision of the chest wall tumor with rib(s) and plastic reconstruction, without lymphadenectomy. 21603 adds mediastinal lymphadenectomy. The operative note must explicitly state whether nodes were dissected — payers audit this distinction directly.

02Can I bill the flap or graft separately when performing 21602?

No. Reconstruction is integral to 21602. Flap and graft codes billed at the same operative session for closure of the chest wall defect will be bundled or denied. Only report reconstruction codes separately if they address a distinct anatomical site not part of the chest wall closure.

03When does modifier 62 apply to 21602?

Use modifier 62 when two surgeons — typically a thoracic or oncologic surgeon and a plastic or reconstructive surgeon — each perform distinct, documented portions of the procedure. Both surgeons append modifier 62. The operative note must delineate each surgeon's specific work.

04How does the 90-day global period affect post-op billing?

All routine follow-up care is included through day 90. Bill a new or unrelated E/M with modifier 24. An unrelated procedure by the same surgeon in the global window requires modifier 79. A related, unplanned return to the OR uses modifier 78.

05Is 21602 appropriate when only soft tissue is excised from the chest wall without rib involvement?

No. Rib involvement is a prerequisite for 21602. Soft-tissue-only tumors of the anterior thorax code to 21552–21558 depending on depth (subcutaneous vs. subfascial) and size. Billing 21602 without documented rib involvement is an audit flag.

06What ICD-10 diagnoses are commonly paired with 21602?

Common diagnoses include primary malignant neoplasm of ribs or sternum (C41.3), secondary malignant neoplasm of the thorax, soft tissue sarcomas involving the chest wall, and chondrosarcoma. Ensure the ICD-10 code reflects rib or chest wall involvement to match code intent.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures rib numbers resected, laterality, reconstruction technique (flap type, mesh, or graft), tumor depth and margin status, and explicit confirmation that no mediastinal lymph node dissection was performed. That last detail is what separates 21602 from 21603 — missing it triggers manual review or a step-down denial.

See how Mira captures CPT 21602 documentation