Surgical removal of a subcutaneous soft tissue tumor in the pelvis or hip area measuring less than 3 cm in greatest dimension.

Verified May 8, 2026 · 6 sources ↓

Medicare: $534.75
Work RVU: 4.82
Global, days: 90
Region: Hip

Drawn from AAPCMdclarityFindacodePayerpriceCMS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify lesion size in centimeters as measured at the time of excision or confirmed by pathology — the threshold for this code is under 3 cm.
Document anatomic location precisely (pelvis, hip, groin, peritrochanteric, etc.) and tissue depth confirming subcutaneous rather than subfascial or intramuscular plane.
Record laterality (left or right) in the operative note to support LT or RT modifiers.
Include pathology report or intraoperative description of lesion character (lipoma, cyst, sebaceous lesion, etc.) to substantiate medical necessity.
If multiple lesions excised in the same session, document each lesion's size and location separately to support additional units or separate procedure billing.
Note the indication for excision — symptomatic, enlarging, or suspected malignancy — to defend medical necessity on payer review.

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 25 Significant separate E/M 50 Bilateral procedure 51 Multiple procedures 57 Decision for surgery 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27047 covers excision of a subcutaneous soft tissue tumor — lipoma, ganglion, or similar lesion — located in the pelvis or hip area, when the specimen measures under 3 cm. The subcutaneous depth distinguishes this code from deeper excisions (27043 for subcutaneous lesions ≥3 cm, 27045 for subfascial/intramuscular lesions). Size is measured as the lesion itself, not the excision margins. If the pathology report or operative note reflects a lesion at or above 3 cm, step up to 27043.

The procedure carries a 90-day global period. Routine post-op visits, wound checks, and suture removal through day 90 are bundled — bill separate E/M services only for unrelated conditions (modifier 24) or a separately identifiable problem addressed same-day as the surgery decision (modifier 57 for the pre-op visit when the decision to operate is made). Site-of-service matters: facility and non-facility RVUs differ, and HOPD and ASC payment rates diverge significantly — see the site-of-service comparison table.

Laterality modifiers (LT, RT) are standard when the operative note specifies a side. Bilateral excisions are uncommon but reportable with modifier 50 on a single line for physician claims; ASCs should split to two lines with LT and RT. If a second distinct soft tissue lesion is excised at a separate site during the same session, modifier 59 supports the additional unit — document each lesion's location and size independently.

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 (4.82) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (16.01) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	4.82
Practice expense RVU	10.06
Malpractice RVU	1.13
Total RVU	16.01
Medicare national rate	$534.75
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	$534.75
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 27047 get rejected.

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

Lesion size not documented or documented at ≥3 cm, triggering a code mismatch — payers auto-downcode or deny when size conflicts with the billed code.
Insufficient medical necessity: asymptomatic lipomas without documented growth, pain, or functional impairment are frequently denied by commercial payers.
Missing or ambiguous laterality when LT or RT modifier is billed but the operative note says only 'hip' without specifying side.
Bundling of the excision with a same-day E/M visit when modifier 25 is absent or the E/M is not separately documented as a distinct service.
Pathology not ordered or not linked — some payers require a pathology report to confirm the excised tissue matches the billed lesion type and size.

Frequently asked questions

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

01What is the size cutoff between 27047 and 27043?

27047 applies when the subcutaneous lesion is less than 3 cm. At 3 cm or greater, use 27043. Size should reflect the lesion dimensions, not the skin incision or excision margins.

02How does 27047 differ from codes in the integumentary chapter for lipoma removal?

Lipomas excised from subcutaneous tissue of the pelvis and hip are coded from the musculoskeletal chapter (27047), not integumentary (11400–11406). The anatomic location — below the integument and in the pelvis/hip region — drives the chapter selection. Document the depth explicitly to avoid a challenge.

03Can 27047 be billed bilaterally?

Yes. For physician claims, report one line with modifier 50. For ASC claims, split to two lines — one with LT, one with RT. Bilateral excisions at the same site are uncommon; document each side independently.

04What happens if I bill a same-day E/M with 27047?

The E/M bundles into the global unless it represents a separate, identifiable service. Append modifier 25 to the E/M and document the distinct problem or decision-making in the note. Modifier 57 applies if the E/M was the visit at which the decision for this surgery was made.

05Does the 90-day global period affect post-op imaging or pathology reporting?

The global covers routine post-op visits and wound care — not pathology review, diagnostic imaging ordered for a new problem, or unrelated E/M visits. Unrelated services billed in the global window need modifier 24 on the E/M or modifier 79 on an unrelated procedure.

06Is prior authorization typically required for 27047?

Many commercial payers require prior authorization for outpatient soft tissue excisions. Requirements vary by payer and plan. Verify before scheduling — denial for missing auth is not appealable on medical necessity grounds alone.

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), anatomic location, laterality, and the clinical indication from the surgeon's dictation — the four variables that determine whether 27047 is the correct code or whether 27043, 27045, or a skin/integumentary code applies instead. Locking these details at the point of dictation prevents the most common audit flag: a documented lesion size that contradicts the billed code.

See how Mira captures CPT 27047 documentation