Radical resection of a soft tissue tumor of the abdominal wall measuring 5 cm or greater, typically performed for malignant neoplasms such as sarcoma.

Verified May 8, 2026 · 5 sources ↓

Medicare: $1,237.50
Total RVUs: 37.05
Global, days: 90
Region: General

Drawn from CMSFacsAAPCPayerpriceFindacode

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 record tumor size plus margin as measured intraoperatively, not from preoperative imaging
Confirm tumor depth — subfascial or intramuscular — to distinguish 22905 from subcutaneous codes 22902/22903
Pathology report confirming tissue origin as soft tissue (not cutaneous) and histologic type (e.g., sarcoma, malignant neoplasm)
Narrative describing extent of resection including tissue planes entered and margin status
Diagnosis codes should reflect malignant or aggressive nature consistent with radical resection; benign tumors rarely justify this code
If reconstruction was required after resection, document separately and confirm it is not bundled under the primary code before billing additional codes

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 57 Decision for surgery 58 Staged or related 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 22905 covers radical resection of a soft tissue tumor arising from the abdominal wall when the tumor plus required margin measures 5 cm or greater at the time of excision. This is the high-complexity code in the 22900–22905 family; code selection hinges on two variables — tumor depth (subcutaneous vs. subfascial/intramuscular) and size. 22905 is the subfascial, large-tumor code and sits at the top of the family's complexity and RVU ladder. Tumor size is measured as greatest diameter plus the narrowest margin needed for complete resection, assessed intraoperatively, not from imaging.

This code sits in the musculoskeletal surgery subsection despite involving the abdominal wall. Do not confuse it with general surgery soft-tissue excision codes or with cutaneous malignancy codes (11600–11646). Lesions of cutaneous origin — including melanoma requiring underlying soft-tissue excision — are reported from the integumentary section, not here. Likewise, subcutaneous abdominal wall tumors under 3 cm use 22902; subfascial tumors under 5 cm use 22900 or 22901 depending on size threshold. Getting that distinction wrong is the single most common upcoding flag auditors raise against this family.

The 90-day global period means the operative day plus 89 postoperative days of routine follow-up are bundled into the base payment. Any unrelated procedure during that window requires modifier 79. A return to the OR for a related complication — wound dehiscence, hematoma — goes with modifier 78. Pre-op evaluation the day before surgery is included in the global; a separately identifiable E/M on that day requires modifier 57 if the decision for surgery was made at that visit.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	21.04
Practice expense RVU	11.18
Malpractice RVU	4.83
Total RVU	37.05
Medicare national rate	$1,237.50
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	$1,237.50
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 22905 get rejected.

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

Tumor size documented only from imaging, not from intraoperative measurement of tumor plus margin
Code billed for a cutaneous-origin malignancy that belongs in the 11600–11646 range instead
Missing or insufficient pathology report to substantiate radical resection rather than simple excision
Upcoding flag when operative note does not clearly document subfascial depth, making 22905 unsupported over 22902 or 22903
Routine post-op services billed separately without modifier during the 90-day global period

Frequently asked questions

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

01How is tumor size determined for code selection between 22900–22905?

Size equals the greatest tumor diameter plus the narrowest margin required for complete excision, measured at the time of surgery. Preoperative imaging measurements alone do not determine code selection.

02Can 22905 be used for a melanoma of the abdominal skin that required wide local excision into the soft tissue?

No. Malignant tumors of cutaneous origin, including melanoma requiring soft-tissue excision, belong in the 11600–11646 range. CPT 22905 is reserved for tumors originating in the soft tissue itself.

03What modifier applies if the surgeon returns to the OR during the 90-day global to manage a wound complication related to the original resection?

Use modifier 78. That signals an unplanned return to the OR for a procedure related to the original surgery during the postoperative period. Modifier 79 applies only to unrelated procedures.

04Is a pre-operative E/M visit the day before surgery billable separately?

Not as a routine visit — the day-before pre-op is included in the 90-day global. If the surgeon made the decision for surgery at that visit, append modifier 57 to the E/M to pull it outside the global.

05What distinguishes 22905 from 22901?

Both are subfascial abdominal wall soft-tissue tumor codes. 22901 covers tumors measuring 5 cm or greater via excision; 22905 is radical resection — a more extensive, margin-driven resection typically indicated for malignancy. Radical resection implies wider tissue removal than simple excision and must be documented as such in the operative note.

06Can modifier 22 be appended to 22905 for an unusually complex resection?

Yes, but only when the operative note explicitly documents what made the work significantly greater than typical — involvement of adjacent structures, prolonged operative time with explanation, or extraordinary hemorrhage control. Without that documentation, payers will deny the upward adjustment.

Sources & references

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

Mira AI Scribe

The Mira AI Scribe captures the surgeon's dictated tumor dimensions plus intraoperative margin, confirms subfascial depth from the operative narrative, and flags whether the lesion origin is soft tissue versus cutaneous — the distinction that drives code family selection. That prevents the most common audit flag against 22905: a note that reports imaging size instead of intraoperative measurement, or one that lacks explicit depth documentation to support the subfascial radical-resection level.

See how Mira captures CPT 22905 documentation