Surgical removal of a tumor less than 5 cm in greatest dimension located within the intramuscular (deep) tissue of the thigh or knee region.

Verified May 8, 2026 · 5 sources ↓

Medicare: $590.19
Total RVUs: 17.67
Global, days: 90
Region: Knee

Drawn from CMSAAPCAAOS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Confirm and document tumor depth as intramuscular — not subcutaneous or subfascial-superficial
Record pre-excision tumor dimensions; <5 cm in greatest dimension is required for 27328 vs. 27329
Operative note must name the specific anatomic location within the thigh or knee, not just 'lower extremity'
Document the surgical approach and extent of dissection through muscle planes
Include pathology specimen label and laterality (left vs. right) in the operative report
If modifier 22 is used, the operative note must explicitly describe what made the work substantially more complex than typical

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 51 Multiple procedures 58 Staged or related 59 Distinct service 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 5 cited references ↓

27328 covers open excision of a deep, intramuscular soft-tissue tumor of the thigh or knee measuring under 5 cm. The intramuscular location is the defining factor — subcutaneous tumors in the same region fall under different codes. Correct code selection hinges on two documented facts: the anatomic depth (deep/intramuscular, not subfascial-superficial) and the measured tumor size. If the specimen measures 5 cm or greater, 27329 applies instead.

27328 carries a 90-day global period. All routine post-operative visits, wound checks, and stitch removals through day 90 are bundled. Bill unrelated E/M services in the global window with modifier 24; use modifier 78 for an unplanned return to the OR for a related complication. Pathology (88305 or appropriate tissue exam code) is always separately billable because it is a distinct professional service by a separate provider.

Site of service matters here. HOPD and ASC payments differ substantially — see the Site of Service comparison table. Tumors that appear aggressive on imaging may warrant modifier 22 if the work substantially exceeded a typical excision, but the operative note must explicitly describe the unusual complexity.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	8.63
Practice expense RVU	7.08
Malpractice RVU	1.96
Total RVU	17.67
Medicare national rate	$590.19
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	$590.19
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 27328 get rejected.

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

Tumor size not documented — payer cannot confirm <5 cm threshold was met
Depth unspecified in operative note; claim downcoded to a superficial excision code
Routine post-op visit billed without modifier 24 inside the 90-day global period
Laterality missing; claim rejected for incomplete procedure identification
Pathology code bundled incorrectly by payer — requires appeal citing separate provider/service logic

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What is the size threshold that separates 27328 from 27329?

27328 applies when the tumor measures less than 5 cm in greatest dimension. Once the specimen hits 5 cm or more, 27329 is the correct code. Document the measurement in the operative report — not just in the pathology report.

02Can I bill a same-day E/M with 27328?

Yes, if the E/M is significant and separately identifiable from the pre-procedure assessment. Append modifier 25 to the E/M. Without modifier 25, payers will bundle the visit into the procedure payment.

03Is pathology separately billable?

Yes. Tissue pathology (e.g., 88305) is a distinct service performed by a separate provider and is not bundled into 27328. Bill it under the pathologist's NPI without a modifier.

04What modifier applies if the patient returns to the OR for a wound dehiscence 3 weeks later?

Modifier 78 — unplanned return to the OR for a complication related to the original procedure, within the 90-day global period. Do not use modifier 79, which is for an unrelated procedure.

05Does 27328 apply to tumors at the knee joint itself, or only the thigh?

The code covers deep tumors in both the thigh (femur region) and the knee. The operative note must specify which anatomic sub-site to satisfy documentation requirements and support laterality reporting.

06When is modifier 22 justified for this excision?

When the tumor's location, adhesions, proximity to neurovascular structures, or prior treatment (e.g., post-radiation fibrosis) substantially increased operative work beyond a routine excision. The operative note must narrate the specific complexity — a generic statement won't survive audit.

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 depth (intramuscular), pre-excision size measurement, anatomic site within the thigh or knee, laterality, and the surgical approach through muscle planes — the exact documentation tripwire that separates 27328 from adjacent codes and prevents depth-based downcoding on audit.

See how Mira captures CPT 27328 documentation