Superficial soft-tissue biopsy of the upper arm or elbow area, removing a tissue sample for histologic analysis.

Verified May 8, 2026 · 6 sources ↓

Medicare: $262.20
Work RVU: 2.08
Global, days: 10
Region: Elbow

Drawn from CMSNIHFastrvuAAPCAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify tissue depth as superficial (subcutaneous layer) — 'superficial' must be explicitly documented to support 24065 over the deep biopsy code
Document the anatomic location within the upper arm or elbow, including laterality (right vs. left)
Include the pre-procedure clinical indication — e.g., palpable mass, suspected neoplasm, inflammatory lesion — with supporting ICD-10 diagnosis
Operative note must describe the incision, dissection depth, specimen size, and confirmation that tissue was sent to pathology
Record the specimen submission to the pathology lab; the lab report should be cross-referenced in the procedure note

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 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 XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 24065 covers a superficial biopsy of soft tissue in the upper arm or elbow region. The surgeon makes a small incision, excises a tissue sample from the subcutaneous or superficial soft-tissue layer, and sends it to pathology. The depth distinction matters: 24065 is the superficial variant. A deep biopsy of the same region is coded separately. With a 10-day global period, routine post-op follow-up through day 10 is bundled — anything unrelated during that window needs modifier 24 or 25.

Dermatology leads in reported volume on the Medicare PUF, but orthopedic and surgical oncology practices bill this code when evaluating upper-extremity soft-tissue masses. Laterality modifiers LT and RT are essential when the claim doesn't specify side in the diagnosis code. If a biopsy is performed bilaterally in the same session, modifier 50 applies.

The HOPD and ASC payment rates for this code differ substantially — see the Site of Service comparison on this page. That gap makes site-of-service selection a meaningful practice management decision. Pathology interpretation is billed separately by the reading physician using the appropriate surgical pathology code.

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 (2.08) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (7.85) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	2.08
Practice expense RVU	5.49
Malpractice RVU	0.28
Total RVU	7.85
Medicare national rate	$262.20
Global period	10 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	$262.20
HOPD (APC 5072) Hospital outpatient department	$1,687.37
ASC (PI P3) Ambulatory surgical center (freestanding)	$184.29

Common denial reasons

The recurring reasons claims for CPT 24065 get rejected.

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

Missing laterality — claim lacks LT or RT modifier and payer cannot determine which extremity was biopsied
Depth not documented — operative note doesn't confirm superficial layer, triggering upcoding or downcoding review
ICD-10 mismatch — diagnosis code is not consistent with a soft-tissue lesion or biopsy indication, causing medical necessity denial
Bundling conflict — billed same-day with an excision code for the same lesion without modifier 59/XS to show distinct service
Global period overlap — billed during another procedure's post-op global period without modifier 79 when the biopsy is unrelated

Frequently asked questions

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

01What is the difference between CPT 24065 and a deep soft-tissue biopsy of the same region?

24065 is the superficial variant — tissue at or above the deep fascia. A deep biopsy in the same anatomic zone is a distinct code. The operative note must confirm depth; without it, auditors cannot verify which code is correct.

02Do I need modifier LT or RT every time?

Yes, whenever the paired ICD-10 code doesn't lock in the side. Most payers require laterality on extremity procedures. Missing it is a common, easily preventable denial reason.

03Can I bill the pathology interpretation with 24065?

The surgical pathology read is billed separately by the interpreting physician using the appropriate surgical pathology CPT code. 24065 covers only the collection procedure.

04What happens if I bill 24065 during another procedure's 10-day global period?

If the biopsy is unrelated to the original procedure, append modifier 79. If it's related and unplanned, modifier 78 applies. Don't bill without one of these in a global period — it will deny as bundled.

05Can 24065 be billed bilaterally in the same session?

Yes. If biopsies are performed on both upper arms or elbows in the same session, append modifier 50. Some payers want LT and RT on separate line items instead — verify payer preference before submitting.

06Why does dermatology lead in Medicare PUF volume for this code even though it's an elbow/upper arm musculoskeletal code?

Superficial soft-tissue lesions in the upper arm are frequently managed by dermatology when the mass appears cutaneous or subcutaneous. Orthopedic surgeons and surgical oncologists are more likely to use this code for deeper-presenting or musculoskeletal-adjacent lesions — but all specialties can bill it when the procedure is performed.

Sources & references

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

Mira Scribe

Mira's AI scribe captures tissue depth (superficial vs. deep), exact anatomic site within the upper arm or elbow, laterality, specimen dimensions, and the pathology submission statement directly from dictation. This prevents the most common audit flag on 24065 — an operative note that documents an incision and tissue removal without confirming the superficial layer or naming the side, which forces coders to query the surgeon and delays billing.

See how Mira captures CPT 24065 documentation