Surgical removal of a subfascial or intramuscular soft tissue tumor of the leg or ankle area measuring less than 5 cm in greatest diameter.

Verified May 8, 2026 · 6 sources ↓

Medicare: $436.22
Total RVUs: 13.06
Global, days: 90
Region: Foot & ankle

Drawn from CMSFacsAAPCEmedny

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm tumor depth explicitly — document subfascial or intramuscular location, not subcutaneous, in the operative note
Record the tumor's greatest diameter in centimeters, measured from the specimen or intraoperative assessment, to justify the <5 cm threshold
Specify anatomic site: leg (tibia/fibula region) or ankle area — vague 'lower extremity' language invites downcoding
Document dissection technique, tissue planes entered, and how the tumor margin was identified and achieved
If additional procedures (neuroplasty, bone biopsy, flap) are billed, document independent clinical indication and distinct operative work for each
Include final pathology report linking specimen to the operative site — required for medical necessity and supports diagnosis coding

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 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27619 covers open excision of a soft tissue tumor located beneath the fascia — subfascial or intramuscular — in the leg (tibia/fibula region) or ankle area, where the tumor measures less than 5 cm. The key distinguishing factors are depth (below the fascia, not subcutaneous) and size (under 5 cm). Subcutaneous tumors under 3 cm go to 27618; subfascial tumors 5 cm or greater go to 27634; radical resection for sarcoma-type lesions goes to 27615 or 27616. Picking the wrong code in this family is the most common audit flag.

The procedure includes simple or intermediate wound closure and all dissection needed to expose and remove the mass. Complex closure, appreciable neuroplasty, adjacent tissue transfer, and flap or graft reconstruction are separately reportable when fully documented and medically necessary. Mere handling of a neurovascular bundle to access the tumor does not justify billing a separate neuroplasty code — the operative note must document independent clinical indication and distinct work. Casting or strapping applied at the same session is not separately billable per NCCI musculoskeletal system policy.

The 90-day global period applies. All routine postoperative visits, wound checks, and suture removal through day 90 are bundled. Unrelated procedures during the global window require modifier 79; a return to the OR for a complication related to the original excision requires modifier 78. Same-day E/M services require modifier 25 if a separately identifiable evaluation drove the surgical decision independently of the pre-procedure assessment.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.74
Practice expense RVU	5.19
Malpractice RVU	1.13
Total RVU	13.06
Medicare national rate	$436.22
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	$436.22
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 27619 get rejected.

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

Depth mismatch: operative note describes a subcutaneous mass but 27619 (subfascial) was billed — payers downcode to 27618 or deny
Size not documented: no measurement recorded in the operative note or pathology report to substantiate the <5 cm criterion
Wrong code family selected: cutaneous-origin lesions (sebaceous cyst, melanoma) should be billed under 11400–11446 or 11600–11646, not 27619
Bundled add-on procedures denied: separately billed neuroplasty or bone excision rejected when operative note shows no independent indication beyond tumor access
Missing or mismatched ICD-10 diagnosis: benign vs. malignant vs. uncertain behavior codes must align with pathology and clinical documentation

Frequently asked questions

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

01What separates 27619 from 27618 and 27634?

Depth and size. 27618 = subcutaneous, <3 cm. 27619 = subfascial/intramuscular, <5 cm. 27634 = subfascial/intramuscular, ≥5 cm. The operative note must document the fascial layer relationship explicitly — payers will downcode to 27618 if depth is ambiguous.

02Can I bill a neuroplasty separately if the tibial nerve was addressed during the same excision?

Only if the operative note documents an independent clinical indication for nerve decompression or repair — not just mobilization of the neurovascular bundle to access the tumor. Routine handling to expose the mass is bundled into 27619. A separate neuroplasty code requires distinct pathology and distinct operative work.

03Is casting or strapping after the excision separately billable?

No. NCCI musculoskeletal system policy prohibits separate billing of casting or strapping when a musculoskeletal procedure (CPT 20100–28899) is performed on the same anatomic area at the same session.

04What modifier applies if the surgeon returns to the OR during the 90-day global for a wound dehiscence related to the original excision?

Modifier 78 — unplanned return to the OR for a procedure related to the original surgery during the global period. Do not use modifier 79 (unrelated procedure) for complications that are sequelae of the index excision.

05Can 27619 be billed for a sebaceous cyst or epidermal inclusion cyst on the leg?

No. CPT guidelines are explicit: cutaneous-origin lesions use the integumentary codes (11400–11446 for benign, 11600–11646 for malignant). 27619 is reserved for tumors arising in the soft tissue beneath the fascia, not lesions of cutaneous origin regardless of where they sit anatomically.

06If the same tumor is excised bilaterally in one session, how is that billed?

Bill 27619 once with modifier 50 for bilateral. Alternatively, some payers prefer 27619-LT and 27619-RT on separate lines. Confirm payer preference — Medicare generally accepts modifier 50 on a single line.

07Does the 90-day global period include the pathology review and results visit?

A routine post-op visit to discuss pathology results within the global period is bundled. If the pathology finding drives a new, separately identifiable E/M decision unrelated to normal post-op care — for example, initiating oncology referral based on unexpected malignancy — modifier 24 allows separate billing of that visit.

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 depth (subfascial vs. subcutaneous), measured diameter in centimeters, precise anatomic location within the leg or ankle, tissue planes entered, and any separately performed procedures with their independent indications. This prevents the two most common denials for 27619: depth misclassification and missing size documentation that trigger automatic downcoding or medical necessity rejections.

See how Mira captures CPT 27619 documentation