Exc neck les sc 3 cm/>
CPT 21552 covers the surgical removal of a large growth or abnormal tissue mass (3 centimeters or larger) from beneath the skin in the neck area. This code applies to excision of subcutaneous lesions that are substantial in size and require more extensive surgical technique.
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
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
NCCI bundling edits
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Billing tips
Document exact lesion size in three dimensions with the largest diameter clearly stated as 3 cm or greater in the operative report
Impact: Lesions documented at 2.9 cm would downcode to 21555 ($310.82), resulting in $131.03 loss per case
Clearly specify subcutaneous depth in documentation; if excision extends into fascia or muscle, consider codes 21556 or 21557 which reimburse higher
Impact: Code 21557 (fascial/muscle, ≥5 cm) reimburses significantly more; accurate depth documentation prevents undercoding
When excising multiple lesions, bill each separately with modifier 59 if they require separate incisions and are at distinct anatomic sites
Impact: Each additional properly documented lesion generates full reimbursement ($441.85) rather than being bundled as a single service
Submit pathology reports with claims when medical necessity is questioned, especially for Medicare LCD compliance in your MAC jurisdiction
Impact: Reduces denial rate by 30-40% and expedites payment by demonstrating medical necessity upfront
For complex excisions near neurovascular structures, document additional time, effort, and technical difficulty to support modifier 22
Impact: Successful modifier 22 appeals can increase reimbursement by $88-220 per case with supporting documentation
Verify the 90-day global period and do not separately bill postoperative visits for routine wound checks
Impact: Prevents denials and potential fraud allegations; global period includes all routine postoperative care
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