Radical resection of a soft tissue tumor (e.g., sarcoma) of the abdominal wall measuring less than 5 cm, including excision of surrounding tissue and any involved anatomical structures beyond the tumor margin.

Verified May 8, 2026 · 6 sources ↓

Medicare: $985.33
Total RVUs: 29.5
Global, days: 90
Region: General

Drawn from CMSAAPCPayerpriceEmedny

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Tumor size recorded as diameter plus required margins — not tumor alone — confirming less than 5 cm threshold for 22904 vs. 22905
Explicit documentation that resection was radical in nature, extending beyond tumor margins to surrounding tissue or involved anatomical structures
Pathology or clinical diagnosis supporting malignant or aggressive tumor type (e.g., sarcoma) justifying radical rather than simple excision approach
Operative note naming specific structures excised beyond the tumor, including fascial layers, muscle, or adjacent tissue — avoid generic 'tumor removed with margins'
If modifier 22 applied, a separate attestation in the operative note quantifying the increased complexity, time, or effort beyond the typical procedure
Imaging or pre-operative workup referenced in the record to support the extent of resection and confirm abdominal wall location

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 22904 covers radical resection of a malignant soft tissue tumor — most commonly sarcoma — arising from the abdominal wall, where the tumor plus margins measure less than 5 cm. Unlike simple excision codes (22900, 22902), radical resection extends beyond the tumor itself to include surrounding tissue and any anatomical structures suspected of involvement. That distinction drives both the higher RVU value and the documentation burden: operative notes must establish why radical — not simple — resection was required.

The 90-day global period applies. Routine post-op visits, wound checks, and dressing changes through day 90 are bundled. Unrelated E/M visits in that window require modifier 24; a separately identifiable same-day E/M needs modifier 25 on the pre-op encounter. If a significantly more complex resection occurs — extensive neurovascular dissection, involvement of adjacent structures requiring reconstruction — modifier 22 with detailed supporting documentation can justify additional reimbursement.

Size threshold is the primary code-selection fork: 22904 is less than 5 cm; 22905 covers 5 cm or greater. Measure tumor diameter plus required margins, not tumor alone. Coding the wrong size tier is one of the most common audit flags for this code family. When the procedure shifts intraoperatively from planned simple excision to radical resection, modifier 22 or an upgrade to the correct radical resection code with a clear operative note is required.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	16.27
Practice expense RVU	9.45
Malpractice RVU	3.78
Total RVU	29.5
Medicare national rate	$985.33
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	$985.33
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 22904 get rejected.

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

Size threshold mismatch: tumor measured without margins, placing the case incorrectly under 22904 when 22905 applies — or vice versa
Radical resection not supported: operative note describes a standard excision with clear margins but coder billed 22904 instead of 22900 or 22902
Missing or inadequate pathology correlation: payer unable to confirm malignant or sarcoma-type diagnosis required to justify radical resection code
Unbundling conflict: separately billed reconstruction or closure codes that are considered integral to the radical resection by payer policy
Global period violation: post-op E/M billed without modifier 24 within the 90-day global window

Frequently asked questions

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

01What separates 22904 from 22900 — when do I use radical resection vs. simple excision?

22900 and 22902 cover excision of soft tissue tumors with clear margins. 22904 applies when resection is radical — extending to surrounding anatomical structures beyond the tumor itself, typically for malignant tumors such as sarcoma where wide tissue clearance is required. The operative note must explicitly support the radical approach.

02How is the 5 cm threshold measured for 22904 vs. 22905?

Measure the tumor diameter plus the required surgical margins combined — not the tumor in isolation. If that total is less than 5 cm, use 22904. If 5 cm or greater, use 22905. Coding based on tumor size alone without margins is an audit risk.

03Can 22904 be billed with reconstruction codes on the same date?

It depends on the payer. Some payers bundle primary closure into the resection; complex reconstruction (e.g., flap coverage) may be separately reportable with modifier 59 or XS if the operative note documents it as distinct and not simply closure of the resection defect. Verify NCCI edits and payer-specific policies before billing both.

04Does the 90-day global period affect how I bill post-op oncology follow-up?

Yes. Routine post-op visits within 90 days are bundled. If the patient is seen for cancer surveillance or a new problem unrelated to the resection, bill the E/M with modifier 24. A separately identifiable pre-op E/M on the day of surgery needs modifier 57 if it led to the decision to operate, or modifier 25 for a distinct same-day evaluation.

05When is modifier 22 appropriate with 22904?

Use modifier 22 when the resection required substantially more work than typical — for example, extensive neurovascular dissection, involvement of multiple tissue planes, or unusually prolonged operative time. The operative note must quantify the added complexity. Modifier 22 without supporting documentation will not survive a payer audit.

06Is 22904 used only for sarcoma, or can it cover other abdominal wall tumors?

The code descriptor references sarcoma as the example, but radical resection of other malignant soft tissue tumors of the abdominal wall can also be captured here when the surgical approach meets the radical resection standard. The diagnosis code must support a malignant or clinically aggressive tumor requiring that extent of surgery.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures tumor location (abdominal wall), measured diameter with margins, the extent of radical resection beyond tumor boundaries, specific structures excised, and the pathologic basis for malignant diagnosis — all from dictation. This prevents the most common 22904 audit trigger: an operative note that documents a wide local excision but fails to establish why radical resection, rather than simple excision, was medically necessary.

See how Mira captures CPT 22904 documentation