Surgical removal of a subcutaneous soft tissue tumor of the leg or ankle area measuring less than 3 cm in greatest dimension.

Verified May 8, 2026 · 7 sources ↓

Medicare: $518.38
Total RVUs: 15.52
Global, days: 90
Region: Foot & ankle

Drawn from CMSMdclarityFindacodeAAPCPayerprice

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Tumor size measured in centimeters — document the greatest dimension explicitly; under 3 cm is required for this code
Anatomic location specified as leg or ankle with laterality (left, right, or bilateral)
Tissue depth confirmed as subcutaneous — documentation must distinguish from subfascial or intramuscular involvement
Operative note describing complete excision, margin status, and specimen handling
Pathology report or documentation that specimen was sent for histologic evaluation
Indication for surgery — symptom-based or diagnostic rationale supporting medical necessity

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 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 7 cited references ↓

CPT 27618 covers open excision of a subcutaneous soft tissue tumor in the leg or ankle that measures under 3 cm. The surgeon removes the mass with adequate margins, and the specimen is typically sent for pathological analysis. Subcutaneous location and tumor size under 3 cm are both required — if the lesion is 3 cm or larger, step up to 27619; if it involves deep fascia or intramuscular tissue, the appropriate deep-tissue excision code applies instead.

The 90-day global period covers all routine post-op care through day 90. Any new, distinct, or unrelated service in that window requires modifier 24 (E/M) or 79 (unrelated procedure). A planned staged excision during the global — for example, re-excision after unexpected positive margins — uses modifier 58. An unplanned return to the OR for a related complication uses modifier 78.

Site of service matters. HOPD and ASC payments differ significantly — see the Site of Service comparison table on this page. When the same surgeon excises tumors from two separate, non-contiguous leg or ankle sites in the same session, modifier 59 (or XS for anatomically distinct site) supports separate billing. Bilateral procedures require modifier 50; laterality modifiers LT or RT apply when a single side is documented.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	3.86
Practice expense RVU	10.88
Malpractice RVU	0.78
Total RVU	15.52
Medicare national rate	$518.38
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	$518.38
HOPD (APC 5072) Hospital outpatient department	$1,687.37
ASC (PI G2) Ambulatory surgical center (freestanding)	$742.04

Common denial reasons

The recurring reasons claims for CPT 27618 get rejected.

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

Tumor size not documented or documented at 3 cm or greater, triggering a code mismatch with 27619
Depth of lesion ambiguous — payers downcode or deny when the note doesn't rule out subfascial or intramuscular origin
Laterality missing from the claim or inconsistent between the operative note and the claim form
Bundling conflict when excision is billed same-day with a wound closure code that is already included
Missing or mismatched ICD-10 diagnosis — benign vs. malignant neoplasm codes must align with pathology findings

Frequently asked questions

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

01What's the threshold between 27618 and 27619?

Tumor size: 27618 is for subcutaneous lesions under 3 cm. 27619 covers subcutaneous lesions 3 cm or larger. Measure and document the greatest dimension in the operative note — the cutoff is strict and payers audit it.

02Can 27618 be billed if the tumor is deep to fascia or intramuscular?

No. 27618 is limited to subcutaneous soft tissue. Deep fascia or intramuscular involvement moves the case to a different code family. Document tissue depth explicitly to support whichever code you bill.

03If two separate tumors are excised from the same leg in the same session, how do you bill?

Bill 27618 for the first excision and append modifier 59 (or XS) to the second if the sites are anatomically distinct and non-contiguous. Document each tumor's size and location separately in the operative note.

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

Modifier 78 — unplanned return to the OR for a procedure related to the original surgery. Do not use modifier 79 here; that is reserved for procedures unrelated to the original case.

05Does the pathology report affect how 27618 is coded?

The pathology result doesn't change the excision code itself, but it drives your ICD-10 selection. Billing a benign neoplasm diagnosis when pathology returns malignancy — or vice versa — is a common audit flag. Amend the claim with corrected diagnosis codes once pathology is finalized if the initial claim was submitted before results returned.

06Is modifier 22 ever appropriate for 27618?

Yes, when the work is substantially greater than typical — for example, extensive adhesions, neurovascular proximity requiring meticulous dissection, or unusually complex anatomy. Attach operative documentation that specifically describes the added complexity; a generic note 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 size in centimeters, subcutaneous depth confirmation, and precise anatomic location with laterality directly from dictation. It flags operative notes that omit a numeric measurement or describe depth in vague terms — the two documentation gaps most likely to trigger a payer size or depth mismatch denial under 27618.

See how Mira captures CPT 27618 documentation