Superficial soft tissue biopsy of the lower leg or ankle area, with specimen sent for pathological evaluation.

Verified May 8, 2026 · 8 sources ↓

Medicare: $260.86
Work RVU: 2.16
Global, days: 10
Region: Foot & ankle

Drawn from CMSAAPCBedrockbillingMdclarityEmedny

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Operative note must specify tissue depth as superficial (above fascia) to support 27613 over 27614
Anatomic location documented as lower leg or ankle — not foot or heel, which may require different coding
Clinical indication documented: mass characteristics, size, symptom duration, and reason biopsy was selected over imaging alone
Pathology requisition and result linked to the encounter to confirm specimen was sent for diagnostic evaluation
Laterality documented (left, right, or bilateral) to support LT/RT or modifier 50 if applicable

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 76 Repeat, same physician 77 Repeat, another physician 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 8 cited references ↓

CPT 27613 covers a superficial (above the fascia) biopsy of soft tissue in the lower leg or ankle region. The specimen is excised and submitted for pathological analysis to evaluate for tumors, infections, inflammatory conditions, or other soft tissue abnormalities. This code sits in the excision subsection for leg and ankle procedures and carries a 10-day global period.

Choosing between 27613 and adjacent codes requires precision. For deep (subfascial or intramuscular) biopsies, use 27614 instead. For skin and subcutaneous punch biopsies — where the target is dermis or subcutaneous fat rather than deeper soft tissue — 11100-series codes may be more appropriate depending on tissue depth and operative intent. The distinction matters: payers and auditors will compare the operative note's described depth against the billed code.

The 10-day global period means routine post-op visits within 10 days of the procedure are bundled. If a medically necessary E/M visit for an unrelated condition falls in that window, append modifier 24. If a separate procedure is performed during the global for an unrelated reason, use modifier 79.

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 (2.16) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (7.81) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	2.16
Practice expense RVU	5.32
Malpractice RVU	0.33
Total RVU	7.81
Medicare national rate	$260.86
Global period	10 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	$260.86
HOPD (APC 5072) Hospital outpatient department	$1,687.37
ASC (PI P3) Ambulatory surgical center (freestanding)	$178.91

Common denial reasons

The recurring reasons claims for CPT 27613 get rejected.

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

Depth not specified in operative note — payer cannot confirm superficial vs. deep, triggering downcoding or denial
Anatomic site documented as foot or heel rather than lower leg or ankle, mismatching the code descriptor
Billed same-day as a skin biopsy code (11100 series) without modifier 59 or XS to establish a distinct site
Missing or delayed pathology report, causing payer to question medical necessity of the biopsy
Global period conflict — E/M billed within the 10-day post-op window without modifier 24

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01What is the difference between 27613 and 27614?

Depth is the sole distinction. 27613 is for superficial biopsies above the fascia; 27614 covers deep (subfascial or intramuscular) biopsies. The operative note must explicitly state the depth — 'superficial' or 'above the fascia' — or auditors will question the code selection.

02Can 27613 and an 11100-series skin biopsy code be billed on the same day?

Yes, if the procedures are performed at anatomically distinct sites and the documentation supports separate medical necessity for each. Append modifier 59 or XS to the lower-valued code to bypass the NCCI bundle. Without that modifier and supporting documentation, Medicare will deny the second code.

03What global period applies to 27613, and what does it cover?

27613 carries a 10-day global period. That window includes the procedure itself and all routine post-op visits directly related to the biopsy through day 10. Unrelated E/M visits in that window need modifier 24; unrelated procedures need modifier 79.

04Should modifier 50 be used if biopsies are taken from both lower legs?

Yes. If the same biopsy procedure is performed bilaterally during the same session, report 27613 with modifier 50. Alternatively, some payers prefer two line items with LT and RT. Check payer-specific billing guidelines before submitting — Medicare generally accepts the single-line modifier 50 approach.

05Can a heel fat pad biopsy be billed as 27613?

Generally no. The heel anatomically falls outside the lower leg and ankle area described by 27613. A punch biopsy targeting subcutaneous heel fat is typically better supported by an 11100-series code. Document the exact site and depth; the operative note is the deciding factor in an audit.

06Is modifier 51 needed when 27613 is billed with another procedure on the same day?

Modifier 51 applies when multiple procedures are performed in the same session and 27613 is not the primary procedure. Apply it to the lower-valued code. Some payers and ASCs handle multiple procedure reductions automatically, but appending modifier 51 is still the correct billing practice in most non-exempt settings.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the tissue depth (superficial vs. subfascial), exact anatomic location within the lower leg or ankle, lesion characteristics, and the clinical indication driving the biopsy decision — all from dictation. That documentation prevents the two most common denials: depth ambiguity that triggers 27614 downcoding, and site mismatch when the note says 'foot' instead of 'ankle' or 'lower leg.'

See how Mira captures CPT 27613 documentation