Surgical removal of a subcutaneous soft tissue tumor measuring 3 cm or greater from the upper arm or elbow area.

Verified May 8, 2026 · 6 sources ↓

Medicare: $391.79
Work RVU: 5.56
Global, days: 90
Region: Elbow

Drawn from CMSAAPCMdclarityFindacodeHopkinsmedicine

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Pathology report or intraoperative measurement confirming tumor size is 3 cm or greater
Operative note specifying the tissue plane — subcutaneous, not subfascial or intramuscular
Anatomic location documented as upper arm or elbow area, with laterality (left or right)
Pre-op imaging or clinical documentation supporting the mass characteristics and surgical indication
Documentation of any increased procedural complexity if modifier 22 is appended
Pathology submission confirmation — excised mass sent to pathology to validate soft tissue tumor diagnosis

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 50 Bilateral procedure 51 Multiple procedures 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 24071 covers open excision of a subcutaneous soft tissue tumor in the upper arm or elbow region when the tumor measures 3 cm or greater. Subcutaneous means the mass sits above the deep fascia — if you're going subfascial or intramuscular, you're in 24073 territory (5 cm or greater) or 24076 (under 5 cm subfascial). Size is measured from the specimen, not the incision, and it has to hit 3 cm to justify 24071 over 24075.

The 90-day global period covers the surgery, the day-before visit, and all routine post-op care through day 90. Unrelated E/M visits in that window need modifier 24. If a staged or planned additional procedure is required in the global, modifier 58 applies. An unplanned return to the OR for a related complication uses modifier 78; unrelated surgery in the global uses modifier 79.

Prior authorization is required at outpatient hospital-based settings per CMS site-of-service policy effective October 2025 (see Johns Hopkins Health Plans reference). Always verify laterality — LT and RT are the expected modifiers, and missing them is a common clean-claim failure for bilateral payers.

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 (5.56) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (11.73) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.56
Practice expense RVU	4.86
Malpractice RVU	1.31
Total RVU	11.73
Medicare national rate	$391.79
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	$391.79
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 24071 get rejected.

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

Size not documented or unclear — payer downcodes to 24075 (under 3 cm) without confirmed measurement
Tissue plane ambiguous — 'deep' or 'subfascial' language in the op note triggers a mismatch with 24073 or 24076
Missing laterality modifier (LT/RT) when payer requires it for clean claim adjudication
Prior authorization not obtained for outpatient hospital-based setting
Bundling conflict when billed same-day with biopsy codes 24065 or 24066 without modifier 59 to establish distinct service

Frequently asked questions

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

01What is the size threshold separating 24071 from 24075?

24071 requires a tumor of 3 cm or greater. 24075 covers subcutaneous tumors under 3 cm in the same upper arm or elbow location. Measurement is of the excised specimen.

02When should I use 24073 instead of 24071?

Use 24073 when the tumor is subfascial (intramuscular) and measures 5 cm or greater. If it's subfascial but under 5 cm, that's 24076. 24071 is strictly subcutaneous — above the deep fascia.

03Does 24071 require prior authorization?

At outpatient hospital-based facilities, yes — prior authorization is required per CMS site-of-service policy effective October 1, 2025. Freestanding ASC settings are listed as non-prior-auth in at least one major payer reference. Verify with the specific payer.

04Can I bill an E/M on the same day as 24071?

Only if the E/M is for a separately identifiable, distinct reason beyond the decision to perform the excision. Append modifier 25 to the E/M. If the visit was solely to plan or confirm the procedure, it folds into the surgical package.

05How do I handle two separate subcutaneous tumors excised from the same arm on the same day?

Each lesion is coded separately. If both are in the upper arm or elbow region and both are 3 cm or greater, report 24071 twice with modifier 51 on the second unit and modifier 59 to establish distinct service if needed. Document separate incisions and separate specimen measurements.

06What modifier applies if I need to return to the OR during the 90-day global for a related complication?

Modifier 78 — unplanned return to the operating room for a procedure related to the original surgery during the global period. Do not use modifier 79 for this scenario; 79 is for unrelated procedures only.

Sources & references

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

Mira Scribe

The Mira AI Scribe captures tumor size from dictation (measured specimen, not incision), tissue plane (subcutaneous versus subfascial), anatomic site (upper arm versus elbow), and laterality. It flags when the operative note uses ambiguous depth language — 'deep' without specifying fascial relationship — which is the leading audit trigger that forces a code swap from 24071 to 24073 or 24076 and a reimbursement gap.

See how Mira captures CPT 24071 documentation