Radical resection of a soft tissue tumor measuring 5 cm or greater, located in the upper arm or elbow region.
Verified May 8, 2026 · 7 sources ↓
- Medicare
- $1,226.15
- Total RVUs
- 36.71
- Global, days
- 90
- Region
- Elbow
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 7 cited references ↓
- Tumor size confirmed at or above 5 cm — document measurement in the operative report and correlate with pre-op imaging
- Operative report must describe the radical resection technique, including margin intent and tissue planes dissected
- Pathology report confirming soft tissue tumor diagnosis (e.g., sarcoma or malignant neoplasm) should be linked to the surgical encounter
- Pre-operative imaging (MRI preferred) documenting tumor location, size, and relationship to surrounding neurovascular structures
- Indication for surgery with diagnostic code supporting malignant or aggressive soft tissue neoplasm of the upper arm or elbow
- Documentation of any neurovascular or reconstructive complexity if billing modifier 22 for increased procedural services
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 7 cited references ↓
CPT 24079 covers radical resection of a soft tissue tumor — typically a sarcoma or other malignant neoplasm — 5 cm or greater in the upper arm or elbow area. This is an oncologic resection, not a simple excision. Radical resection implies wide margins with removal of the tumor and a surrounding cuff of normal tissue, often requiring dissection around neurovascular structures. The size threshold (≥5 cm) and the radicality of the approach are what separate this code from its lower-intensity counterpart (24077, tumor <5 cm).
The 90-day global period applies. That window covers all routine post-op care through day 90, including wound checks, drain management, and staple removal. If the patient requires a return to the OR for a related complication during that window, use modifier 78. An unrelated procedure in the same global period requires modifier 79. Separate E&M visits for tumor surveillance or oncology coordination unrelated to surgical recovery require modifier 24.
Site of service significantly affects payment. HOPD and ASC rates differ substantially — see the Site of Service comparison table on this page. Most payers follow CMS global and bundling rules, but commercial carriers and Medicaid managed care plans may apply different prior authorization requirements for oncologic soft tissue resections; verify before scheduling.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 20.09 |
| Practice expense RVU | 12 |
| Malpractice RVU | 4.62 |
| Total RVU | 36.71 |
| Medicare national rate | $1,226.15 |
| 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 | $1,226.15 |
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 24079 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Tumor size not documented at ≥5 cm in the operative note — payer downcodes to 24077
- Procedure described as 'excision' rather than 'radical resection' in the operative note, causing code-to-documentation mismatch
- Missing or delayed pathology report at time of claim submission, triggering medical necessity denial
- Incorrect modifier use during the 90-day global period — post-op E&M visits without modifier 24 denied as bundled
- Prior authorization not obtained for oncologic soft tissue resection before the procedure date
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 7 cited references ↓
01What distinguishes CPT 24079 from CPT 24077?
02Can 24079 be billed if the final pathology comes back benign?
03Does the 90-day global period affect post-op oncology follow-up visits?
04When is modifier 22 appropriate with 24079?
05Is modifier 50 ever used with 24079?
06How does site of service affect reimbursement for 24079?
07What NCCI bundling issues should billers watch for with 24079?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02mdclarity.comhttps://www.mdclarity.com/cpt-code/24079
- 03aapc.comhttps://www.aapc.com/codes/cpt-codes/24079
- 04cms.govhttps://www.cms.gov/files/document/04-chapter4-ncci-medicare-policy-manual-2025finalcleanpdf.pdf
- 05emedny.orghttps://www.emedny.org/providermanuals/physician/pdfs/physician%20procedure%20codes%20sect5.pdf
- 06cgsmedicare.comhttps://www.cgsmedicare.com/medicare_dynamic/j15/partb/ptpb/ptp.aspx
- 07payerprice.comhttps://payerprice.com/rates/24079-CPT-fee-schedule
Mira AI Scribe
Mira's AI scribe captures tumor size from dictation, the specific anatomic location within the upper arm or elbow, and the surgeon's description of resection margins and tissue planes — the three elements most likely to trigger a downcode or medical necessity denial. It flags operative notes that omit the word 'radical' or fail to record a measured tumor dimension, preventing the most common mismatch between code 24079 and submitted documentation.
See how Mira captures CPT 24079 documentation