Excision of a subcutaneous soft tissue tumor or lesion in the hip or pelvic region measuring 3 cm or larger.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $453.92
- Work RVU
- 6.71
- Global, days
- 90
- Region
- Hip
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 5 cited references ↓
- Measured lesion size in centimeters — must be documented ≥3 cm to support 27043 over 27041
- Tissue layer of origin: explicitly state subcutaneous (above the deep fascia) to differentiate from deep/intramuscular tumor codes
- Anatomic location: specify hip, pelvis, buttock, or groin — 'pelvic region' alone is insufficient for audit defense
- Operative note describing the surgical approach, dissection plane, and method of excision
- Pathology report submitted and reconciled with the operative report lesion description
- Preoperative imaging (MRI or ultrasound) documenting size and depth when available, especially for lesions near the 3 cm threshold
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 5 cited references ↓
CPT 27043 covers open excision of a subcutaneous soft tissue tumor or lesion located in the hip or pelvis when the lesion measures 3 cm or greater. The subcutaneous designation is critical — this code applies to masses arising in the tissue layer beneath the skin but above the deep fascia. Lesions that invade or originate below the fascia require a different code family (27047–27049 for deep/intramuscular tumors). Common lesions billed under 27043 include lipomas, soft tissue masses of the buttock, and subcutaneous tumors of the groin or peritrochanteric region.
The 90-day global period means all routine post-op care from the day of surgery through day 90 is bundled into the surgical payment. New, unrelated problems presenting in that window require modifier 24 on any E/M. A separately identifiable E/M on the day of surgery needs modifier 25. If pathology confirms malignancy and a wider re-excision is planned within the global, bill the return surgery with modifier 78 (related, unplanned return to OR) or 58 (staged/planned) depending on the clinical scenario.
Site of service matters substantially here. HOPD and ASC payment rates differ significantly — see the Site of Service comparison table on this page. For bilateral lesions excised in the same session, modifier 50 applies. If two distinct lesions are excised at the same anatomic region in the same session, modifier 59 or XS establishes the separate procedure identity, though NCCI bundling edits must be checked against any companion codes.
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 (6.71) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (13.59) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 6.71 |
| Practice expense RVU | 5.23 |
| Malpractice RVU | 1.65 |
| Total RVU | 13.59 |
| Medicare national rate | $453.92 |
| 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 | $453.92 |
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 27043 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Lesion size not documented or measured — payer downcodes to 27041 (under 3 cm) when size is absent from the operative note
- Depth of lesion unclear — failure to specify subcutaneous vs. subfascial triggers a code-mismatch denial or audit request
- Unbundling with integumentary excision codes (e.g., 11400–11406) when the lesion is actually subcutaneous musculoskeletal — payers reject the integumentary code as incorrect code family
- Missing or mismatched ICD-10 diagnosis — benign vs. malignant neoplasm codes must align with pathology results post-op
- Global period violations — E/M billed within 90 days post-op without modifier 24 for an unrelated condition
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01What separates 27043 from 27041?
02When should I use 27047 instead of 27043?
03Can I bill 27043 for a buttock mass?
04How do I handle a same-day E/M with 27043?
05If the surgeon excises two separate subcutaneous lesions in the hip/pelvis region during the same session, how do I bill?
06Does the 90-day global include the pathology interpretation fee?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
Mira Scribe
Mira's AI scribe captures lesion size in centimeters, tissue depth (subcutaneous vs. subfascial), and precise anatomic location (buttock, groin, peritrochanteric) directly from surgeon dictation. It flags operative notes that omit a numeric measurement or describe depth ambiguously — the two documentation gaps most likely to trigger a downcode to 27041 or a payer request for additional records.
See how Mira captures CPT 27043 documentation