Excision of a subfascial or intramuscular soft tissue tumor of the pelvis or hip area measuring 5 cm or greater in greatest diameter including margin.

Verified May 8, 2026 · 6 sources ↓

Medicare: $691.73
Work RVU: 10.85
Global, days: 90
Region: Hip

Drawn from CMSFacsAAPCMdclarityFindacode

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Tumor size recorded as greatest diameter plus excision margin, measured at time of surgery — not from pre-op imaging
Explicit documentation of subfascial or intramuscular depth; 'deep' alone is insufficient
Anatomic location within the pelvis or hip area specified in the operative note
Operative note must describe dissection through fascial or muscle planes to confirm subfascial/intramuscular access
Pathology specimen submitted and labeled with site and size to cross-reference operative measurements
Indication for excision documented — whether benign, indeterminate, or malignant based on pre-op workup

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 50 Bilateral procedure 51 Multiple procedures 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 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 6 cited references ↓

27045 covers surgical removal of a deep soft tissue tumor — subfascial or intramuscular — located in the pelvis or hip region, where the tumor plus the excision margin measures 5 cm or greater. Code selection hinges on two variables: anatomic depth (subfascial/intramuscular vs. subcutaneous) and size at excision. The measurement used is the greatest diameter of the tumor plus the margin required for complete removal, assessed at the time of excision — not on pre-op imaging alone.

This code sits in a family of soft tissue tumor excision codes built around location and size. For hip/pelvis subfascial tumors under 5 cm, use 27043. Cutaneous-origin lesions (sebaceous cysts, melanoma with soft tissue extension) do not belong here; route those to the 11400–11646 series. The 90-day global period means all routine post-op management through day 90 is bundled — bill modifier 24 for unrelated E/M services and modifier 78 for unplanned related returns to the OR within that window.

The top billing specialty in CMS PUF data is urology, which reflects pelvic mass excisions crossing anatomic service lines. Orthopedic and surgical oncology practices should expect payer scrutiny on depth documentation and size measurement methodology. Imaging alone is insufficient to establish the 5 cm threshold — operative note measurement at time of excision is required.

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 (10.85) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (20.71) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	10.85
Practice expense RVU	7.43
Malpractice RVU	2.43
Total RVU	20.71
Medicare national rate	$691.73
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	$691.73
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 27045 get rejected.

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

Size not documented at time of excision — pre-op MRI measurement submitted instead of intraoperative measurement
Depth insufficiently documented; payer downcodes to subcutaneous excision code 27041 when 'subfascial' or 'intramuscular' is absent from operative note
Cutaneous-origin lesion (e.g., sebaceous cyst) billed under 27045 instead of the correct 11400–11446 series
Routine post-op E/M billed without modifier 24 inside the 90-day global period
Claim submitted without pathology report, triggering medical necessity review and suspension

Frequently asked questions

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

01How is tumor size determined for code selection — pre-op MRI or intraoperative measurement?

Intraoperative measurement controls. Size equals the greatest diameter of the tumor plus the margin required for complete excision, assessed at the time of surgery. Pre-op imaging may guide planning but cannot substitute for the operative measurement in the note.

02What's the difference between 27043 and 27045?

Both cover subfascial/intramuscular hip and pelvis tumors. 27043 is for tumors under 5 cm; 27045 is for 5 cm or greater. Depth classification (subfascial vs. subcutaneous) is the other axis — subcutaneous tumors go to 27041 (under 5 cm) or 27043 does not apply; check the full code family.

03Can 27045 be billed for a sebaceous cyst or lipoma arising in the skin overlying the hip?

No. Cutaneous-origin lesions belong in the 11400–11446 (benign) or 11600–11646 (malignant) series. 27045 requires the tumor to originate in subfascial or intramuscular soft tissue, not the dermis or subcutaneous fat above the fascia.

04How does the 90-day global period affect post-op billing?

All routine follow-up visits, dressing changes, and stitch removals through day 90 are bundled. Unrelated E/M services need modifier 24. An unplanned return to the OR for a related complication takes modifier 78. A separately scheduled unrelated procedure in the global window takes modifier 79.

05When is modifier 22 appropriate for 27045?

Use modifier 22 when the work was substantially greater than typical — for example, a tumor with extensive adhesion to neurovascular structures requiring prolonged dissection, or intraoperative hemorrhage management that materially increased time and complexity. Document the specific factors driving increased work in the operative note; without that narrative, payers routinely deny the upcharge.

06Why does urology top the PUF billing data for 27045?

Pelvic soft tissue tumors frequently cross anatomic service lines. Urologists managing retroperitoneal or parapelvic masses that fall within the pelvis/hip soft tissue coding geography account for a significant share of 27045 claims. Orthopedic and surgical oncology practices should not assume the code is unusual for their specialty — it is appropriate whenever the anatomic and depth criteria are met.

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 intraoperative tumor measurement (greatest diameter plus margin), the specific fascial or muscular plane of dissection, and the anatomic subsite within the pelvis or hip from dictation. That prevents the most common 27045 downcode: a vague operative note that omits 'subfascial' or 'intramuscular' depth and fails to record the 5 cm threshold measurement at the time of excision.

See how Mira captures CPT 27045 documentation