Radical resection of a soft tissue tumor (e.g., sarcoma) of the pelvis and hip area measuring 5 cm or greater, including removal of surrounding tissue margins.

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,643.66
Total RVUs: 49.21
Global, days: 90
Region: Hip

Drawn from CMSNIHAAPCFindacodeMdclarity

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 as 5 cm or greater — measured at greatest dimension in operative or pathology report
Anatomic location specified as pelvis and/or hip area, not generically described
Operative note describes radical (wide-margin) resection, not simple excision or debulking
Histologic or pathologic confirmation of tissue type (e.g., sarcoma, malignant neoplasm) tied to ICD-10 diagnosis
If modifier 22 is appended, note must detail increased complexity: operative time, blood loss, proximity to neurovascular structures, or extent of tissue removal beyond standard
Laterality documented when modifier LT or RT is used

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 27059 covers radical resection of a soft tissue tumor — sarcoma being the prototypical example — in the pelvis and hip region when the lesion is 5 cm or larger. The procedure involves wide excision of the tumor mass along with a cuff of surrounding normal tissue; it is not a simple excision or debulking. Size is measured at the greatest dimension of the lesion as documented in the operative or pathology report.

The 90-day global period means all routine post-op care through day 90 is bundled. Complications requiring a return to the OR for a related procedure use modifier 78. Unrelated OR procedures in the same global window use modifier 79. If a separate, distinct procedure is performed at a different anatomic site on the same day, modifier 59 or XS applies — but document the distinct site explicitly; different diagnoses alone won't override NCCI bundling.

This code sits at the high end of orthopedic oncology RVU values, reflecting the complexity of the pelvic/hip anatomy, proximity to neurovascular structures, and the wide margins required. Laterality modifiers (LT/RT) apply when the tumor is clearly unilateral. Modifier 22 is appropriate when operative complexity substantially exceeds the typical case — but requires a supporting letter with operative time, blood loss, and specific anatomical obstacles documented in the note.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	28.62
Practice expense RVU	14.36
Malpractice RVU	6.23
Total RVU	49.21
Medicare national rate	$1,643.66
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	$1,643.66
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 27059 get rejected.

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

Tumor size not documented or measured in the operative/pathology report — payer downcodes to 27047 (less than 5 cm)
ICD-10 diagnosis code does not support malignant or aggressive neoplasm of the pelvis/hip region, triggering medical necessity denial
Modifier 22 appended without supporting documentation of unusual complexity — payer removes and reprices at base RVU
Separate same-day procedure billed without modifier 59 or XS where NCCI bundling edits apply
Missing or incomplete operative note — facility claim processes but professional claim denies for lack of documentation

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What separates 27059 from 27047?

Size threshold. CPT 27047 covers soft tissue tumor excision of the pelvis and hip under 5 cm; 27059 is 5 cm or greater. The pathology report or operative note must document the measurement. If size is ambiguous, expect a downcode to 27047.

02Does 27059 require a malignant diagnosis to bill?

The code description cites sarcoma as an example, but the procedure is defined by surgical technique — radical (wide-margin) resection — not exclusively by malignancy. Aggressive benign tumors requiring wide margins can qualify. That said, payers scrutinize non-malignant diagnoses more closely, so document medical necessity explicitly.

03Can you bill a biopsy code on the same day as 27059?

Not if the biopsy is performed as part of the same excision. If a separate diagnostic biopsy was performed at a distinct site or in a prior encounter, that's a different scenario. Same-session biopsy-within-excision is bundled.

04When does modifier 22 apply to 27059?

When the case is materially more complex than a standard radical resection of this type — for example, extensive neurovascular involvement, prior radiation field, or reconstruction requirements that significantly extended operative time. Attach a cover letter quantifying the added complexity; modifier 22 without supporting documentation is routinely rejected.

05Is 27059 billed with LT or RT, and does modifier 50 ever apply?

LT or RT should be appended whenever the tumor is clearly unilateral, which is typical for pelvis/hip soft tissue tumors. Modifier 50 (bilateral) is rare for this code given the anatomy but is technically applicable if radical resection is performed on both sides at the same session.

06What global period applies and what does it include?

27059 carries a 90-day global period. That covers the day-before pre-op visit, the procedure, and all routine post-op care through day 90. Unrelated procedures in the global window need modifier 79. A related return to the OR uses modifier 78.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures tumor size at greatest dimension, anatomic location within the pelvis or hip, resection margin description (wide, radical), proximity to neurovascular structures, estimated blood loss, and operative time — all from dictation. That prevents the most common denial: a payer downcode to 27047 because size or radical intent wasn't explicit in the note.

See how Mira captures CPT 27059 documentation