Radical resection of a soft tissue tumor of the leg or ankle, where the tumor and surrounding margin of normal tissue measure 5 cm or larger.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,158.68
Total RVUs: 34.69
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCFindacodeMdclarityAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Preoperative imaging (MRI preferred) confirming tumor size, location, and tissue involvement in the leg or ankle region
Operative note documenting the surgical approach, anatomic boundaries of resection, and explicit specimen dimensions (must be 5 cm or greater)
Pathology report confirming tissue type and margin status — links medical necessity to the radical resection approach
Diagnosis code (ICD-10) consistent with malignant or aggressive soft tissue neoplasm of the leg or ankle
Post-op plan documenting follow-up within the 90-day global period, with any separately billable services flagged with appropriate modifiers

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27616 covers radical resection of a soft tissue tumor — typically a malignant neoplasm — of the leg (tibia/fibula region) or ankle, with a resected specimen of 5 cm or greater. Radical resection means en bloc removal of the tumor with a cuff of normal surrounding tissue, not simple excision or debridement. The size threshold distinguishes 27616 from its smaller-specimen counterpart; if the resected mass is under 5 cm, a different code applies.

This is a high-complexity soft tissue procedure carrying a 90-day global period. All routine post-op visits, wound checks, and dressing changes through day 90 are bundled. Anything unrelated to the tumor resection billed during the global window requires modifier 24 (E/M) or modifier 79 (unrelated procedure). An unplanned return to the OR for a related complication — say, wound dehiscence or hematoma — uses modifier 78.

Documentation must establish medical necessity through imaging and pathology correlation, confirm the surgical approach and anatomic location, and record the specimen size explicitly. Operative notes that omit tumor dimensions or describe margins vaguely are the primary audit target for this 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	19.14
Practice expense RVU	11.38
Malpractice RVU	4.17
Total RVU	34.69
Medicare national rate	$1,158.68
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	$1,158.68
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 27616 get rejected.

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

Specimen size not documented or ambiguous — payer downcodes to the sub-5 cm code without an explicit measurement in the operative note
CPT-ICD-10 mismatch — using a benign tumor diagnosis code with a radical resection code triggers medical necessity denial
Unbundling of incidental procedures performed at the same site without a modifier 59 or XS where an NCCI PTP edit applies
Global period violations — billing a related E/M or wound care visit within 90 days without modifier 24 or 78 as appropriate
Site-of-service mismatch between the claim and the facility where the procedure was performed

Frequently asked questions

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

01What distinguishes 27616 from the smaller-tumor leg/ankle resection code?

The size threshold. 27616 applies when the resected specimen is 5 cm or larger. The smaller-tumor code covers resections below that threshold. Document the measurement explicitly — 'approximately 5 cm' is not sufficient for most payers.

02Does 'radical resection' require confirmed malignancy on pathology before billing?

No. You bill based on the procedure performed, not the final pathology result. If the surgeon performed a radical resection with en bloc margins at the time of surgery, 27616 is appropriate even if final pathology returns benign. The ICD-10 diagnosis should reflect the pre-op clinical picture — use a suspected or confirmed malignancy code if that was the indication.

03Can 27616 be billed the same day as a bone resection or reconstructive procedure?

Yes, with modifier 51 appended to the additional procedure. Check NCCI PTP edits for the specific code pair. If a flap closure or grafting is performed at the same operative session, those are typically separately reportable with the appropriate modifier.

04How does the 90-day global period affect post-op oncology follow-up visits?

Routine post-op visits are bundled. If a visit addresses a new or unrelated problem — including oncology management outside the surgical site — append modifier 24 to the E/M code. If the visit results in a return to the OR for an unrelated procedure, use modifier 79.

05Is 27616 billable bilaterally, and how should bilateral cases be reported?

Bilateral resection of leg or ankle tumors would be unusual clinically but is reportable. For physician claims, append modifier 50. For ASC claims, report on two separate lines using modifiers LT and RT per NCCI bilateral reporting requirements.

06What modifier applies if the surgeon returns to the OR for wound complications after 27616?

Modifier 78 covers an unplanned return to the OR for a complication related to the original procedure within the global period — such as hematoma evacuation or wound dehiscence repair. Modifier 79 is for an unrelated procedure performed during the global window. Do not invert these.

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 location (leg vs. ankle), resection margins, specimen size in centimeters, and surgical approach from dictation — directly preventing downcoding to the sub-5 cm code due to missing dimensions. It also flags the 90-day global start date so billing staff can apply modifiers 24, 78, or 79 correctly on subsequent claims.

See how Mira captures CPT 27616 documentation