CPT 21015Surgery

Resect face/scalp tum < 2 cm

CPT code 21015 covers the surgical removal of a small tumor (less than 2 centimeters) from the face or scalp, including the skin and underlying tissue. This is typically performed for skin cancers or suspicious growths that need complete removal and examination.

Showing rates for

National Average

Base Medicare rate

$688.01

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

9.89

PE RVU (NF)

9.67

MP RVU

1.71

Total RVU

21.27

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Document precise tumor size measurement in operative report using calipers or ruler, not visual estimation, and confirm the largest diameter is under 2cm to support 21015 rather than 21016
Impact: Prevents upcoding denials and downcoding; difference between 21015 ($688.01) and incorrect 21016 assignment is significant
Clearly differentiate radical resection from simple excision (11640-11646) by documenting depth of dissection, involvement of subcutaneous tissue/fascia, and wide margin requirements in operative note
Impact: Simple excision codes reimburse $150-300 less; proper documentation supports the additional $400-538 for radical resection approach
Include pathology report confirmation of tumor type and verification that margins were examined as part of the medical record when submitting claims
Impact: Reduces denial rate by 30-40% for medical necessity; establishes clinical justification for radical vs. simple approach
Bill in appropriate setting (facility vs. non-facility) as Medicare rates are identical for 21015 at $688.01, but private payers may differ significantly
Impact: While Medicare pays equally, commercial payers may show 20-40% variation between settings; verify contract rates
When performing multiple tumor resections in same session, list 21015 as primary code if it represents the most extensive/complex resection to maximize reimbursement
Impact: Primary procedure receives 100% payment ($688.01) while additional procedures reduced to 50%; proper sequencing can save $300-400 per case
For reconstruction performed immediately following tumor resection, bill appropriate adjacent tissue transfer codes (14040-14060) separately as they are not bundled with 21015

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 21015 in 2025?

Medicare pays $688.01 for CPT 21015 in 2025 for both facility and non-facility settings. This is based on 21.27 total RVUs (9.89 work RVU + 9.67 practice expense RVU + 1.71 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 21015 and skin excision codes 11640-11646?

CPT 21015 is a radical resection involving wider margins and deeper tissue dissection including fascia or muscle, typically for malignant tumors. Codes 11640-11646 are simple excisions limited to skin and subcutaneous tissue. The radical approach (21015) reimburses $688.01 compared to $200-400 for simple excisions, reflecting the increased surgical complexity and risk.

How do I bill CPT 21015 if the tumor measures exactly 2 centimeters?

A tumor measuring exactly 2.0 cm falls into the 'less than 2 cm' category and should be coded as 21015. Only tumors measuring 2.1 cm or greater would qualify for 21016. Document the precise measurement to the millimeter in your operative report to support your code selection.

Can I bill reconstruction codes separately with CPT 21015?

Yes, complex repairs (13100-13160) and adjacent tissue transfers (14040-14060) are separately reportable with CPT 21015 and are not bundled. Simple or intermediate repairs are included in the surgical package. Document reconstruction as a distinct procedure with separate time and complexity to support additional billing.

What modifiers are most commonly used with CPT 21015?

Modifier 51 for multiple procedures, modifier 58 for staged reconstructions during the global period, modifier 78 for return to OR for margin re-excision, and modifier 22 for unusual complexity are most common. Modifier RT/LT may be required by some payers to indicate laterality on facial procedures.

How many RVUs is CPT code 21015 worth in 2025?

CPT 21015 has a total of 21.27 RVUs in 2025, consisting of 9.89 work RVUs, 9.67 practice expense RVUs (both facility and non-facility), and 1.71 malpractice RVUs. These values are from the CMS Physician Fee Schedule released December 2024.

What documentation is required to support medical necessity for CPT 21015?

Required documentation includes pre-operative biopsy confirming malignancy or aggressive tumor type, precise tumor measurements under 2cm, operative note detailing depth of dissection and margin width, pathology report confirming tumor characteristics, and clinical rationale for choosing radical resection over simple excision. Photos are highly recommended to prevent denials.