Excision of a soft tissue lesion from the muscle or subfascial layer of the lower leg or ankle area, with tissue submitted for pathological evaluation.

Verified May 8, 2026 · 6 sources ↓

Medicare: $610.23
Work RVU: 5.66
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAOSAAPC

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Depth confirmation: document that the lesion is subfascial or intramuscular, not superficial or subcutaneous
Clinical indication for open biopsy versus needle or imaging-guided technique
Anatomic location and laterality (right vs. left lower leg or ankle area) stated explicitly in the operative note
Pathology order and specimen submission documentation linking biopsy site to lab report
Pre-operative imaging or prior diagnostic workup supporting the need for surgical biopsy
Operative note specifying surgical approach and dissection depth — avoid generic language like 'standard approach'

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 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 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

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27614 covers open biopsy of deep soft tissue in the lower leg or ankle region — specifically muscle or subfascial structures. The procedure is diagnostic: the surgeon removes tissue for pathological analysis to characterize a lesion that cannot be adequately evaluated by imaging or superficial sampling alone. This is not a simple punch or needle biopsy; it requires surgical access to subfascial depth.

The code carries a 90-day global period. All routine follow-up visits, wound checks, and stitch removals through day 90 are bundled. If a separate E/M is medically necessary on the day of surgery for an unrelated problem, append modifier 25. Services during the global period for unrelated conditions require modifier 24.

Laterality matters here. Always append LT or RT to identify which leg. If the procedure is performed bilaterally in the same session — unusual but possible in cases of suspected systemic disease — report with modifier 50 and document the clinical rationale for bilateral sampling.

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 (5.66) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (18.27) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.66
Practice expense RVU	11.69
Malpractice RVU	0.92
Total RVU	18.27
Medicare national rate	$610.23
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	$610.23
HOPD (APC 5073) Hospital outpatient department	$2,967.63
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,248.36

Common denial reasons

The recurring reasons claims for CPT 27614 get rejected.

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

Missing laterality modifier (LT or RT) causing claim rejection at clearinghouse or payer edit
Lesion depth not documented as subfascial or intramuscular — payers downcoding to a superficial biopsy code
Lack of medical necessity documentation when imaging or prior non-surgical evaluation was not attempted first
Unbundling errors when a separate excision code is also reported for tissue removed at the same site during the same session
Global period conflicts when a follow-up visit is billed without modifier 24 during the 90-day window

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What distinguishes 27614 from a superficial soft tissue biopsy of the lower leg?

27614 is for deep (subfascial or intramuscular) tissue. If the lesion is subcutaneous — above the fascia — a different, lower-valued code applies. The operative note must state the depth explicitly; 'soft tissue biopsy' alone is not sufficient and will draw audit scrutiny.

02Do I need modifier LT or RT every time I bill 27614?

Yes. The lower leg is a paired structure and payers expect a laterality modifier on every claim for 27614. Omitting LT or RT is one of the most common reasons this code hits a front-end edit or gets rejected outright.

03Can 27614 and an E/M be billed on the same day?

Yes, if the E/M is significant, separately identifiable, and documented as such. Append modifier 25 to the E/M code. Without modifier 25, the E/M will be bundled into the surgical service and denied.

04What happens if the patient needs a follow-up biopsy of an unrelated site during the 90-day global?

Bill the new biopsy with modifier 79 (unrelated procedure during global period). Modifier 79 tells the payer the new procedure is outside the original global bundle. Do not use modifier 78, which is reserved for unplanned returns for a complication related to the original procedure.

05Is 27614 appropriate when the biopsy is performed under ultrasound guidance?

27614 describes an open surgical biopsy. If the procedure is performed percutaneously under imaging guidance, a different code family applies. If imaging guidance is used as an adjunct during an open procedure, document that clearly and verify whether a separate guidance code is billable or bundled under NCCI edits.

06The pathology came back benign — does that affect the 27614 claim?

No. CPT codes describe what was done, not what was found. A benign result does not retroactively invalidate the procedure code. However, the original indication for biopsy must have been clinically supported at the time of service to withstand a medical necessity review.

Sources & references

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

Mira Scribe

Mira's AI scribe captures lesion depth (subfascial vs. intramuscular vs. subcutaneous), anatomic location within the lower leg or ankle, laterality, surgical approach, and confirmation that the specimen was sent to pathology. That documentation prevents the two most common downcoding triggers: depth ambiguity and missing laterality — both of which audit teams flag before a claim even reaches clinical review.

See how Mira captures CPT 27614 documentation