Surgical removal of a subfascial (e.g., intramuscular) soft tissue tumor of the leg or ankle area measuring 5 cm or greater in diameter.

Verified May 8, 2026 · 6 sources ↓

Medicare: $623.26
Work RVU: 9.88
Global, days: 90
Region: Foot & ankle

Drawn from AAPCMdclarityNIHCMSAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Tumor size documented in centimeters — must confirm 5 cm or greater to support 27634 over the smaller-size code 27632
Depth of tumor confirmed as subfascial (below the fascia, e.g., intramuscular) — superficial tumors route to a different code family
Operative note identifies the specific anatomic location within the leg or ankle area, not just 'lower extremity'
Pathology report or intraoperative specimen documentation confirming tumor tissue was submitted
Anesthesia type and patient positioning documented in the operative note
Pre-op imaging (MRI preferred) or clinical measurement documenting size and subfascial depth of the lesion

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 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 27634 covers excision of a subfascial soft tissue tumor — typically intramuscular — located in the lower leg or ankle region when the tumor measures 5 cm or more. The surgeon dissects through the fascial layer to reach the tumor, removes it with a margin of surrounding tissue to confirm complete excision, then closes the fascia and skin in layers. A pathology specimen is standard; the procedure addresses both benign and malignant lesions at this depth and size threshold.

The 90-day global period means all routine postoperative care through day 90 is bundled. Unrelated procedures or E/M visits in that window require modifier 79 or 24/25, respectively. Debridement within the surgical field is not separately reportable per NCCI Chapter 4 policy — don't append a debridement code unless it's at a clearly distinct site.

Site of service matters here: the HOPD and ASC payment rates differ substantially (see the Site of Service comparison table). If the tumor shows characteristics suggesting malignancy, confirm the ICD-10 diagnosis supports medical necessity before submitting — payers frequently scrutinize high-RVU soft tissue tumor excisions for diagnosis-code mismatches.

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 (9.88) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (18.66) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	9.88
Practice expense RVU	6.86
Malpractice RVU	1.92
Total RVU	18.66
Medicare national rate	$623.26
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	$623.26
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 27634 get rejected.

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

Tumor size not documented at or above 5 cm — payer downcodes to 27632 (less than 5 cm) without explicit measurement
Depth ambiguity — note says 'deep' without specifying subfascial or intramuscular, triggering a medical review request
ICD-10 diagnosis code does not match benign vs. malignant tumor distinction expected by payer policy
Debridement code billed separately for tissue in the same surgical field — bundled per NCCI and denied without a valid distinct-site modifier
Modifier absent on a same-session procedure that triggers an NCCI PTP edit, resulting in the secondary code being denied

Frequently asked questions

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

01What distinguishes 27634 from 27632?

Size and depth are both relevant, but the key split between 27632 and 27634 is tumor size: 27632 covers subfascial tumors under 5 cm, 27634 covers 5 cm or greater. Both require subfascial depth. If the measurement isn't in the note, expect a downcode to 27632.

02Can I bill a debridement code alongside 27634 if significant necrotic tissue was encountered?

No, if the debridement is within the surgical field of the tumor excision. Per NCCI Chapter 4, debridement in the operative field of a musculoskeletal procedure is bundled and not separately reportable. A debridement at a genuinely distinct anatomic site with modifier 59 may be defensible, but document the separation explicitly.

03Does 27634 carry a global period, and what does that mean for postoperative E/M billing?

Yes — 27634 has a 90-day global. Routine post-op E/M visits through day 90 are bundled. If you see the patient for an unrelated problem, append modifier 24 to the E/M. If a staged or related procedure is performed in the global window, modifier 58 or 78 applies depending on whether it was planned.

04When should modifier 22 be used with 27634?

Use modifier 22 when the work substantially exceeded typical — for example, a tumor with extensive vascular involvement, adherence to critical neurovascular structures, or unusually complex closure. Document the added complexity in the operative note with specific language; generic statements like 'difficult case' won't support it on audit.

05Is 27634 appropriate for malignant tumors, or only benign lesions?

27634 covers both benign and malignant subfascial tumors of the leg and ankle at or above 5 cm. The ICD-10 diagnosis code should accurately reflect benign vs. malignant status. A malignant diagnosis may trigger additional payer scrutiny or prior authorization requirements, particularly for commercial payers.

06How does site of service affect reimbursement for 27634?

Significantly. The HOPD and ASC payment rates for 27634 differ — see the Site of Service comparison table on this page. If your patient qualifies and the case is appropriate for an ASC, understand the facility payment differential before scheduling, especially for in-office vs. outpatient decisions.

Sources & references

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

Mira Scribe

Mira's AI scribe captures tumor size in centimeters, confirms subfascial depth (e.g., intramuscular), records the exact anatomic location within the leg or ankle, and notes whether a specimen was sent to pathology — directly from dictation. This prevents the most common downcoding trigger: an operative note that says 'large deep tumor' without a documented measurement that clears the 5 cm threshold for 27634.

See how Mira captures CPT 27634 documentation