Surgical excision of a subfascial or intramuscular soft tissue tumor of the upper arm or elbow area measuring 5 cm or greater in its largest dimension.

Verified May 8, 2026 · 7 sources ↓

Medicare: $653.32
Total RVUs: 19.56
Global, days: 90
Region: Elbow

Drawn from CMSAAPCFindacodeNIHMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Tumor depth confirmed as subfascial or intramuscular — not merely subcutaneous
Greatest single dimension of excised specimen documented as 5 cm or greater, preferably from pathology report or operative measurement
Laterality documented — left or right arm/elbow
Operative note specifies the tissue planes entered and describes the dissection through or beneath the fascia
Pathology report submitted to confirm soft tissue tumor diagnosis and correlate with ICD-10 diagnosis code (benign vs. malignant vs. uncertain behavior)
Indication for surgery and pre-operative imaging (MRI preferred) referenced in the note to support medical necessity

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 25 Significant separate E/M 50 Bilateral procedure 51 Multiple procedures 57 Decision for surgery 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

24073 covers open removal of a deep soft tissue tumor — subfascial or intramuscular — located in the upper arm or elbow region when the lesion measures 5 cm or more. 'Deep' is the operative distinction here: the surgeon must penetrate the fascial plane to reach an intramuscular mass, making this a substantially more complex dissection than subcutaneous excisions coded under 24071. Tumor size is measured from the pathology or operative specimen; use the greatest single dimension to select the code.

The 90-day global period applies. All routine post-op visits, wound checks, and dressing changes through day 90 are bundled. Separate E/M visits in that window require modifier 24. A staged or planned second procedure in the global period requires modifier 58; an unplanned return to the OR for a related complication requires modifier 78.

For laterality, always append LT or RT. If the same-day operative note documents a separately identifiable E/M that drove a new decision — for example, new imaging findings discussed intraoperatively — modifier 25 is not applicable post-surgery; use modifier 24 for post-op E/M or modifier 57 for a pre-operative decision visit the day of or day before surgery. Debridement within the same surgical field is not separately reportable per NCCI policy.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.88
Practice expense RVU	7.43
Malpractice RVU	2.25
Total RVU	19.56
Medicare national rate	$653.32
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	$653.32
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 24073 get rejected.

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

Tumor size not documented or ambiguous — payers deny or downcode when the operative note lacks a clear measurement of 5 cm or greater
Depth descriptor missing — billing 24073 when the note only supports subcutaneous dissection triggers downcoding to 24071
Laterality modifier (LT/RT) absent — Medicare and many commercial payers reject elbow/arm codes without a side indicator
ICD-10 diagnosis code mismatch — submitting a benign lipoma code against a claim coded as if malignant, or using an unspecified neoplasm code when pathology is available
Unbundling wound repair — separately billing closure or debridement within the same surgical field, which NCCI bundles into 24073

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01How do I pick between 24071 and 24073?

24071 is subcutaneous (above the fascia), 3 cm or greater. 24073 is subfascial or intramuscular, 5 cm or greater. The fascial plane the surgeon crosses — not just size — drives the code selection. If the note doesn't document penetrating the fascia, you can't bill 24073 regardless of tumor size.

02Which tumor dimension determines code selection — the largest or smallest?

Use the greatest single dimension. If pathology reports 6 x 3 cm, code to 6 cm. The AAPC coding community and standard practice consistently apply the largest diameter to select the size threshold.

03Can I bill wound repair separately with 24073?

No. Closure of the surgical wound is included in the global package. Debridement within the same surgical field is also not separately reportable per NCCI Chapter 4 policy. Don't add repair codes unless you're closing a wound at a completely separate anatomic site.

04What modifier applies if the surgeon returns to the OR for post-op bleeding?

Modifier 78 — unplanned return to the OR for a complication related to the original procedure during the global period. Modifier 79 is for an unrelated procedure in the global period. Don't invert them.

05Is 24073 payable in an ASC setting?

Yes. CMS assigns a separate ASC payment rate for 24073 — see the Site of Service comparison table on this page. HOPD payment is higher. Always verify the facility's payer contracts, as commercial ASC rates vary significantly.

06When is modifier 22 appropriate for 24073?

When the operative complexity was substantially greater than typical — for example, a tumor with extensive adhesions to neurovascular structures requiring prolonged dissection. The operative note must explicitly document the additional time, difficulty, and clinical factors. Without that documentation, payers will strip the modifier.

07Does the 90-day global period affect post-op imaging or new symptom visits?

Post-op imaging ordered as part of routine tumor surveillance within 90 days is bundled. An E/M for a new, unrelated condition in the global period requires modifier 24 with documentation clearly establishing the visit was not for a complication or routine follow-up of the excision.

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 depth (subfascial vs. subcutaneous), the measured greatest dimension of the lesion, laterality, and the specific tissue planes entered during dissection — all from dictation. This prevents the two most common downcodes: missing depth documentation that triggers a fallback to 24071, and absent size documentation that causes payers to deny 24073 for failing the 5 cm threshold.

See how Mira captures CPT 24073 documentation