Open biopsy of deep subfascial or intramuscular soft tissue in the pelvis and hip region, performed to characterize a mass as benign, malignant, or precancerous.

Verified May 8, 2026 · 6 sources ↓

Medicare: $654.99
Total RVUs: 19.61
Global, days: 90
Region: Hip

Drawn from CMSAAPCAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify tissue depth explicitly — subfascial or intramuscular — to justify 27041 over 27040 (subcutaneous) or 20206 (needle biopsy).
Document that an incision was made; percutaneous needle approaches do not support this code.
Identify the anatomic location within the pelvis or hip region (e.g., gluteal, iliopsoas, obturator).
Record the size and characteristics of the lesion targeted for biopsy.
Note the clinical indication — suspected malignancy, indeterminate mass, staging — to support medical necessity.
If billed same-day with a major hip procedure, document that the biopsy site was distinct and independently indicated.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 24 Unrelated E/M during global 25 Significant separate E/M LT Left side RT Right side 80 Assistant surgeon AS PA/NP/CNS assistant XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27041 covers an open surgical biopsy of deep soft tissue — subfascial or intramuscular — located in the pelvis or hip area. It is distinct from 27040, which addresses superficial (subcutaneous) tissue in the same region. Neither code applies to needle biopsies: when no incision is made, report 20206 (needle biopsy, muscle) instead. If imaging guidance is used for a percutaneous approach, that pathway also routes to 20206 plus the appropriate guidance code, not 27041.

The 90-day global period means the pre-op visit, the operative session, and all routine post-op management through day 90 are bundled into the single payment. Separate E/M visits during that window require modifier 24 (unrelated) or 25 (significant, separately identifiable, same day). A subsequent procedure for a related complication — say, wound dehiscence requiring return to the OR — bills with modifier 78. An unrelated procedure in the global window gets modifier 79.

Don't report 27041 alongside a major hip procedure (e.g., total hip arthroplasty) without modifier 59 or XS and solid documentation that the biopsy was a distinct, separately necessary service on a different lesion or site. Payers routinely bundle it as incidental to the primary procedure without that support. NCCI policy also prohibits reporting a fine needle aspiration (FNA) code and a biopsy code for the same lesion at the same encounter — report only one.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.93
Practice expense RVU	7.67
Malpractice RVU	2.01
Total RVU	19.61
Medicare national rate	$654.99
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	$654.99
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 27041 get rejected.

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

Bundled as incidental when billed same-day with a major hip procedure (e.g., 27130) without modifier 59 or XS and supporting documentation.
Code mismatch: payer downcodes to 20206 when operative note describes a needle approach rather than open incision.
Insufficient depth documentation — note says 'soft tissue biopsy' without specifying subfascial or intramuscular depth, triggering a 27040 vs. 27041 dispute.
FNA and biopsy reported for the same lesion at the same encounter, violating NCCI policy — only one code is payable.
Missing or inadequate medical necessity documentation when payer requests clinical indication for the biopsy.

Frequently asked questions

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

01What's the difference between 27040 and 27041?

Depth. CPT 27040 covers superficial (subcutaneous) soft tissue biopsies in the pelvis and hip. CPT 27041 applies when the biopsy goes deep — subfascial or intramuscular. Your operative note must name the depth; 'soft tissue biopsy' alone won't hold up on audit.

02When should I use 20206 instead of 27041?

Any time the biopsy is performed percutaneously without an incision — including CT- or ultrasound-guided core needle biopsies — report 20206, not 27041. The 27040/27041 family requires an open surgical approach. AAPC coding forums and CMS parenthetical guidance both direct needle biopsies to 20206.

03Can I bill 27041 on the same day as a total hip arthroplasty?

Yes, but only with modifier 59 or XS and clear documentation that the biopsy was performed on a separate, distinct lesion that independently warranted tissue sampling. Without that, payers bundle it as incidental. The AAPC forum thread on 27137 + 27041 illustrates exactly how that denial plays out.

04Does the 90-day global period affect how I bill post-op complications?

Yes. A return to the OR for a related complication (e.g., hematoma evacuation) within 90 days bills with modifier 78. An unrelated surgical procedure in the same window gets modifier 79. Routine office visits during the global are bundled — bill separately only with modifier 24 if the visit is for an unrelated problem.

05Can I report an FNA code and 27041 together for the same lesion?

No. NCCI policy is explicit: report only one biopsy code per lesion per encounter. If an FNA was attempted and yielded an adequate specimen, stop there. If the FNA specimen was inadequate and you proceeded to an open biopsy, report only the open biopsy code.

06Does site of service affect payment for 27041?

Yes, significantly. The HOPD and ASC payment rates differ — see the site-of-service comparison table on this page. Performing the procedure in an ASC versus a hospital outpatient department changes the facility payment substantially, which affects your contracting and scheduling decisions.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures the tissue depth (subfascial vs. intramuscular), the specific anatomic site within the pelvis or hip, confirmation that an open incision was made, lesion size, and the clinical indication driving the biopsy. That depth and approach documentation is what separates a clean 27041 claim from a downcode to 27040 or a redirect to 20206 — the two most common audit flags on this code.

See how Mira captures CPT 27041 documentation