Open biopsy of superficial (subcutaneous) soft tissue in the pelvis and hip region, above the fascia.

Verified May 8, 2026 · 6 sources ↓

Medicare: $342.03
Total RVUs: 10.24
Global, days: 10
Region: Hip

Drawn from CMSAAPCFindacodeMdclarityEmedny

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm and document tissue depth as superficial/subcutaneous — above the fascia — to distinguish from 27041 (deep subfascial/intramuscular)
Specify anatomic location within the pelvis and hip area (e.g., lateral hip, inguinal region, gluteal region)
Document the clinical indication for biopsy — tumor, infection, unexplained mass, or other suspected pathology
Record the biopsy technique used (incisional, excisional) and confirm open approach, not needle/CT-guided
Note laterality (left, right, or bilateral) explicitly in the operative report
Include pathology order and specimen labeling confirming tissue was sent for histologic evaluation

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 LT Left side RT Right side 80 Assistant surgeon

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

27040 covers an open biopsy of superficial soft tissue in the pelvis and hip area — tissue located between the skin and the fascia (subcutaneous layer). The surgeon removes a tissue sample for pathologic analysis to evaluate for malignancy, infection, or other abnormality. Depth is the defining factor: 27040 is superficial (subcutaneous); if the biopsy goes deep subfascial or intramuscular, bill 27041 instead. If imaging guidance is used for a needle biopsy of soft tissue in this region, the correct code is 20206 — not 27040 or 27041.

The global period is 010, meaning routine follow-up through postoperative day 10 is bundled. Services beyond that window, or for unrelated conditions during those 10 days, need modifier 24 or 79 as applicable. Laterality modifiers (LT/RT) apply when the operative site is unilaterally documented; bill modifier 50 only if biopsies are performed on both sides in the same session.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	2.85
Practice expense RVU	6.96
Malpractice RVU	0.43
Total RVU	10.24
Medicare national rate	$342.03
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	$342.03
HOPD (APC 5072) Hospital outpatient department	$1,687.37
ASC (PI A2) Ambulatory surgical center (freestanding)	$742.04

Common denial reasons

The recurring reasons claims for CPT 27040 get rejected.

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

Wrong code selected — deep subfascial or intramuscular biopsy billed as 27040 instead of 27041
Needle or CT-guided biopsy billed as 27040 — imaging-guided needle biopsy of soft tissue requires 20206
Missing or vague depth documentation — operative note states 'superficial' without specifying subcutaneous vs. subfascial layer
Laterality not documented — LT/RT modifier appended without corresponding operative note specifying the side
Bundling edit triggered when 27040 is billed same-day with a more comprehensive excision or resection of the same lesion without modifier 59

Frequently asked questions

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

01What is the difference between 27040 and 27041?

Depth. 27040 is superficial — subcutaneous tissue above the fascia. 27041 is deep — subfascial or intramuscular. The operative note must state which layer was sampled; 'superficial' alone is not sufficient if it doesn't confirm subcutaneous location.

02Can I bill 27040 for a CT-guided or ultrasound-guided needle biopsy of hip soft tissue?

No. Imaging-guided needle biopsies of soft tissue use 20206, not 27040 or 27041. CPT guidelines for the 27040–27041 code pair specifically redirect needle biopsy to 20206.

03What global period applies to 27040?

010 — a 10-day global. Routine follow-up visits through postoperative day 10 are bundled. An unrelated procedure or E/M during those 10 days needs modifier 79 or 24, respectively.

04Should I use modifier LT or RT with 27040?

Yes, when the biopsy is performed on a single side. Append LT or RT based on the operative site. If biopsies are performed on both sides in the same session, bill with modifier 50 instead.

05Can 27040 be billed on the same day as a soft tissue excision at the same site?

Generally no — if the biopsy is followed immediately by excision of the same lesion, the excision code captures the entire work. If the biopsy and excision are at distinct, separate sites, modifier 59 is required with supporting documentation.

06Is pathology billing separate from 27040?

Yes. 27040 covers the surgical collection only. The pathology interpretation is billed separately by the pathologist using the appropriate surgical pathology code (88302–88309 range depending on complexity).

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures tissue depth (subcutaneous vs. subfascial), exact anatomic site within the pelvis/hip region, laterality, and the open biopsy approach from dictation — the four variables that separate 27040 from 27041, drive LT/RT modifier selection, and prevent downcodes or medical necessity denials on audit.

See how Mira captures CPT 27040 documentation