Radical resection of a soft tissue tumor in the hip or pelvis region measuring less than 5 cm, performed via open surgery with wide excision margins.
Verified May 8, 2026 · 7 sources ↓
- Medicare
- $1,291.95
- Total RVUs
- 38.68
- 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 7 cited references ↓
- Tumor size documented in centimeters — confirmed less than 5 cm by pathology report or preoperative imaging measurement
- Operative note specifies radical resection with en-bloc removal and description of tissue margins obtained
- Pathology report confirming tumor histology, grade, and margin status
- Anatomic location within the pelvis or hip area clearly stated — not generically as 'soft tissue mass'
- Clinical indication documenting malignant or aggressive tumor behavior justifying radical approach
- If modifier 22 is appended, operative note must detail increased complexity, additional time, and specific technical challenges encountered
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 7 cited references ↓
CPT 27049 covers open radical resection of a soft tissue tumor — typically malignant or aggressively behaving — located in the pelvis or hip area, where the tumor measures under 5 cm at its greatest dimension. Radical resection means wide en-bloc removal with a margin of normal surrounding tissue; this is not a simple excision or marginal shelling-out. The sub-5 cm size threshold is what separates 27049 from its counterpart covering larger tumors — confirm measurement is documented from the final pathology specimen or preoperative imaging, not estimated intraoperatively.
This is a 90-day global procedure. All routine postoperative care through day 90 is bundled. Separate E/M visits during that window require modifier 24 (unrelated problem) or 25 (same-day, significant separately identifiable service). Reconstruction performed at the same session — such as soft tissue flap coverage or wound closure requiring additional work — may support modifier 22 if the operative note documents substantially increased complexity and time.
The HOPD and ASC payment rates differ materially; site-of-service matters for margin analysis and pre-authorization planning. Payers managing oncologic cases often require prior authorization and pathology correlation before approving the radical resection designation — document the clinical rationale for radical versus marginal resection explicitly in the operative report.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 21.01 |
| Practice expense RVU | 13.2 |
| Malpractice RVU | 4.47 |
| Total RVU | 38.68 |
| Medicare national rate | $1,291.95 |
| 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 | $1,291.95 |
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 27049 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Tumor size not documented or exceeds 5 cm threshold — code mismatch with the larger-tumor counterpart code
- Operative note describes marginal or simple excision technique rather than radical resection with clear margins
- Missing pathology report at time of claim submission, causing payer to flag unverified malignant designation
- Prior authorization not obtained for oncologic resection — many payers require it for radical soft tissue procedures
- Global period violation — postoperative E/M billed without modifier 24 or 25 within the 90-day window
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 7 cited references ↓
01What separates 27049 from the code for larger hip/pelvis tumor resections?
02Does 'radical resection' require a malignant diagnosis?
03Can I bill for reconstruction performed at the same session as the 27049 resection?
04How does the 90-day global period affect oncology follow-up visits?
05Is prior authorization typically required for CPT 27049?
06If a frozen section changes the surgical plan intraoperatively, does the code change?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02findacode.comhttps://www.findacode.com/cpt/27049-cpt-code.html
- 03mdclarity.comhttps://www.mdclarity.com/cpt-code/27049
- 04cms.govhttps://www.cms.gov/medicare/regulations-guidance/physician-self-referral/list-cpt-hcpcs-codes
- 05cgsmedicare.comhttps://www.cgsmedicare.com/medicare_dynamic/j15/partb/ptpb/ptp.aspx
- 06cms.govhttps://www.cms.gov/files/document/medicaid-ncci-correspondence-language-manual-02282026.pdf
- 07ams.aaos.orghttps://ams.aaos.org/Online-Store/Product-Detail?id=54670860-57C1-EF11-B8E8-6045BD03FF0D
Mira AI Scribe
Mira's AI scribe captures tumor size in centimeters from dictation, the surgeon's explicit description of radical en-bloc resection technique, margin status, and the anatomic sub-site within the pelvis or hip region. It also flags when dictation uses language like 'excised' or 'shelled out' — phrasing that implies marginal rather than radical resection — so the operative note reflects the correct surgical intent before the claim goes out.
See how Mira captures CPT 27049 documentation