Radical resection of a soft tissue tumor in the thigh or knee area measuring 5 cm or greater, including excision of the tumor with wide margins of surrounding tissue.

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,430.56
Total RVUs: 42.83
Global, days: 90
Region: Knee

Drawn from CMSAAPCFindacodeMdclarityEmedny

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Pre-operative imaging report (MRI or CT) confirming tumor size of 5 cm or greater and anatomic location within the thigh or knee soft tissue
Pathology or biopsy report supporting the diagnosis (e.g., sarcoma, malignant neoplasm) prior to or at time of resection
Operative note explicitly stating the radical resection approach, margin intent, and tissue planes entered — 'standard excision' language is insufficient and will flag audits
Specimen measurement documented intraoperatively or in the pathology report confirming 5 cm or greater threshold to justify 27364 over lower-threshold codes
Laterality documented (left vs. right thigh/knee) to support LT/RT modifier use
Postoperative pathology final report confirming surgical margin status (positive vs. negative margins affects oncologic follow-up documentation)

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 58 Staged or related 59 Distinct service 76 Repeat, same physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 27364 covers radical resection of a soft tissue tumor — typically a sarcoma or other malignant neoplasm — located in the thigh or knee area, where the tumor measures 5 cm or greater. The procedure involves wide-margin excision: the surgeon removes the tumor along with a cuff of surrounding normal tissue to achieve oncologically clear borders. This goes well beyond simple excision or enucleation, and the distinction matters for code selection. Contrast with 27339 (subfascial excision, 5 cm or greater, non-radical) and 27365 (radical resection involving bone of the femur or knee). If the pathology ultimately determines the lesion is benign but the surgical approach was radical at the time of resection, 27364 may still apply — document the pre-operative imaging, biopsy results, and intraoperative decision-making.

The 90-day global period means all routine post-operative management, wound checks, and drain removal fall inside the package. Any E&M service within the global period for a new or unrelated problem requires modifier 24. An unplanned return to the OR for a related complication — hemorrhage, wound dehiscence — uses modifier 78. An unrelated procedure performed during the global period uses modifier 79. Do not invert these two.

Because this is a high-complexity oncologic resection, reconstruction (flap coverage, nerve grafting, vascular repair) performed at the same session may be separately reportable with modifier 51, provided the work is distinct and documented independently. Pre-operative MRI or CT is standard of care and separately billable; it is not bundled into the surgical code.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	23.88
Practice expense RVU	13.61
Malpractice RVU	5.34
Total RVU	42.83
Medicare national rate	$1,430.56
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	$1,430.56
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 27364 get rejected.

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

Tumor size not documented at or above the 5 cm threshold — payers downcode to 27339 or 27337 without confirmed measurement
Operative note does not distinguish radical resection from standard excision — descriptor language must support wide-margin oncologic intent, not routine soft tissue removal
Missing or mismatched ICD-10 diagnosis code — benign neoplasm codes paired with a radical resection code trigger medical necessity review; confirm malignancy or aggressive behavior is coded
Unbundling of reconstruction performed at the same session without modifier 51 and separate documentation of distinct surgical work
Global period violations — E&M services billed within 90 days without modifier 24 or 79 to establish unrelatedness

Frequently asked questions

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

01What separates 27364 from 27339?

27339 is subfascial excision of a soft tissue tumor 5 cm or greater — not radical. 27364 is radical resection, meaning wide margins with intent to achieve oncologically clear borders, typically for sarcoma or malignant neoplasm. The operative approach and margin intent must be explicit in the note, not just the tumor size.

02When does 27365 apply instead of 27364?

27365 is radical resection of bone of the femur or knee — use it when the tumor involves or requires resection of osseous structures. If the resection is purely soft tissue with no bone involvement, 27364 is correct. Mixed involvement requires careful operative note documentation to support whichever code is billed.

03Can reconstruction be billed separately on the same day as 27364?

Yes, if the reconstruction (e.g., flap coverage, nerve repair) is a separately documented, distinct procedure. Append modifier 51 to the secondary procedure. The operative note must describe each procedure's start, approach, and closure independently — a single narrative covering both will draw bundling scrutiny.

04What modifier applies if the patient returns to the OR for wound dehiscence during the 90-day global?

Modifier 78 — unplanned return to the operating room for a related procedure during the global period. Do not use modifier 79, which is reserved for unrelated procedures. The return-to-OR note must establish the clinical relationship to the original resection.

05Does a benign final pathology invalidate 27364?

Not automatically. If pre-operative imaging and biopsy supported a malignant diagnosis and the surgeon performed a radical resection based on that clinical picture, the code can stand. Document the pre-op reasoning clearly. If no pre-op malignancy workup existed and the lesion was excised without oncologic margins, expect a medical necessity challenge.

06Is modifier 22 available if the resection required vascular or nerve involvement significantly increasing work?

Yes. Modifier 22 applies when the procedure required substantially more work than typical — documented examples include involvement of major neurovascular structures requiring dissection or repair, or a prior surgical field from previous excision. The operative note must quantify the additional work, and a cover letter explaining the complexity should accompany the claim.

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 anatomic location, measured size (intraoperative and pathology), the radical resection approach including margin description, tissue planes entered, and laterality — directly from dictation. That documentation closes the gap auditors target most: operative notes that describe the incision and closure without establishing why 27364 applies over a lower-level excision code, preventing downcoding and medical necessity denials.

See how Mira captures CPT 27364 documentation