Surgical excision of a subfascial or intramuscular soft tissue tumor of the upper arm or elbow area, with the tumor measuring less than 5 cm in greatest dimension.

Verified May 8, 2026 · 5 sources ↓

Medicare: $521.05
Work RVU: 7.22
Global, days: 90
Region: Elbow

Drawn from CMSNIHAAPCFindacodeAoassn

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Tumor size in centimeters — document the measured specimen dimension, not estimated or incision length
Confirm subfascial or intramuscular depth; note that dissection passed through fascia to reach the tumor
Anatomic location: specify upper arm versus elbow area and laterality (left or right)
Operative note must name the surgical approach and describe tumor characteristics (consistency, adherence, margins)
Pathology specimen submission — include pathology report or order in the record
Pre-op imaging (MRI preferred) supporting deep tumor location and size under 5 cm

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 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 24076 covers open removal of a deep soft tissue tumor — subfascial or intramuscular — located in the upper arm or elbow region, where the lesion is under 5 cm. 'Deep' here means below the fascia, distinguishing it from subcutaneous excisions. If the tumor is 5 cm or larger, step up to CPT 24077. For superficial (subcutaneous) tumors of the same region, CPT 24075 applies regardless of size.

The 90-day global period means all routine post-op visits, wound checks, and dressing changes through day 90 are bundled. Any unrelated E/M service billed during that window needs modifier 24. If a new and distinct problem is addressed the same day as surgery, use modifier 25 on the E/M — but document the separate medical necessity clearly.

Accurate size documentation is the hinge point for this code. The measured dimension of the excised specimen (not the incision length) must appear in the operative note. Tumors at or above 5 cm that are coded to 24076 instead of 24077 are a common audit target.

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 (7.22) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (15.6) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.22
Practice expense RVU	6.82
Malpractice RVU	1.56
Total RVU	15.6
Medicare national rate	$521.05
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	$521.05
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 24076 get rejected.

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

Tumor size at or above 5 cm documented in op note or path report — should be billed as 24077
Insufficient documentation of subfascial depth; payer downcodes to 24075 (subcutaneous)
Missing laterality modifier (LT or RT) required by many commercial payers and MACs
ICD-10 diagnosis code inconsistent with a benign or malignant soft tissue neoplasm of the upper arm/elbow
Unbundling of incision and closure when billed separately alongside 24076

Frequently asked questions

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

01What separates 24076 from 24075?

Depth. CPT 24075 is for subcutaneous (above the fascia) tumors; 24076 requires the tumor to be subfascial or intramuscular. Size does not factor into the 24075 vs. 24076 distinction — depth does.

02When should I use 24077 instead of 24076?

Use 24077 when the deep soft tissue tumor of the upper arm or elbow measures 5 cm or greater. The cutoff is at 5 cm — a tumor documented as exactly 5 cm goes to 24077, not 24076.

03Do I need modifier LT or RT on 24076?

Most MACs and commercial payers require laterality modifiers for unilateral procedures on paired anatomic sites. Append LT or RT on every 24076 claim. Missing laterality is a common clean-claim failure.

04Can I bill an E/M on the same day as 24076?

Yes, if a separately identifiable evaluation and management service was performed for a problem beyond the surgical indication. Append modifier 25 to the E/M and document the distinct medical necessity in the note.

05Is modifier 22 ever appropriate for 24076?

Yes — when the excision required substantially more work than typical due to tumor adherence to neurovascular structures, prior scarring, or unusual anatomical complexity. Document the specific factors that increased operative time and difficulty; modifier 22 without supporting narrative will be denied.

06What ICD-10 codes pair with 24076?

Common diagnoses include benign neoplasm of connective and soft tissue of upper limb (D21.1-) and malignant neoplasms of soft tissue of the upper extremity. The diagnosis must specify a soft tissue neoplasm — a generic 'arm mass' code without neoplasm specificity increases denial risk.

07Is 24076 performed in ASC or hospital outpatient settings, and does site of service affect payment?

24076 is performed in both HOPD and ASC settings. CMS payment rates differ between the two sites — see the Site of Service comparison table on this page. Document medical necessity for the chosen setting when payer policy requires it.

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 size from dictation, flags the depth descriptor (subfascial vs. intramuscular vs. subcutaneous), and records laterality — the three fields that most often trigger downcoding or denial on 24076. If the surgeon dictates a size at or above 5 cm, the scribe surfaces a prompt to verify whether 24077 is the correct code before the claim is submitted.

See how Mira captures CPT 24076 documentation