CPT 21555Surgery

Exc neck les sc < 3 cm

CPT code 21555 covers the surgical removal of a benign or abnormal growth located under the skin of the neck when the lesion measures less than 3 centimeters in diameter. This is a common outpatient procedure performed under local anesthesia to remove cysts, lipomas, or other soft tissue masses.

Showing rates for

National Average

Base Medicare rate

$422.77

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

3.96

PE RVU (NF)

8.3

MP RVU

0.81

Total RVU

13.07

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

NCCI bundling edits

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Billing tips

Measure and document lesion size in operative note in at least two dimensions (length x width) before excision and confirm measurement is <3cm; if ≥3cm, use 21556 instead
Impact: Prevents downcoding or denial; 21556 pays $559.67 non-facility vs $422.77 for 21555—$136.90 difference per case
Always send excised tissue for pathological examination and reference the pathology order in operative documentation; medical necessity often depends on pathology findings
Impact: Pathology documentation supports medical necessity and prevents denials for cosmetic procedures; absence can trigger 100% claim denial
Bill in non-facility setting (office surgical suite) when possible rather than hospital outpatient; practice receives full non-facility rate
Impact: Non-facility rate of $422.77 vs facility rate of $304.70 means practice captures additional $118.07 per procedure when performed in office
For multiple lesions, bill 21555 for first lesion and append modifier 59 to subsequent lesions; ensure separate documentation for each lesion's size, location, and pathology
Impact: Each additional lesion at reduced rate (typically 50%) adds approximately $211 per lesion; without modifier 59 expect bundling denial
Document depth of lesion explicitly as 'subcutaneous' or 'superficial to muscle fascia'; if deeper structures involved, different codes apply (21557 for ≥5cm radical resection)
Impact: Prevents downcoding to simple skin lesion removal (11420-11426 series) which pay $150-$250 less, or upcoding audits if depth not documented
When performed with E/M on same day, document that decision for surgery was made during that visit and append modifier 25 to E/M code only, not to 21555

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 21555 in 2025?

Medicare pays $422.77 for CPT 21555 in non-facility settings and $304.70 in facility settings based on the 2025 Medicare Physician Fee Schedule. The code has a total RVU of 13.07 (Work RVU 3.96, Non-Facility PE RVU 8.3, Facility PE RVU 4.65, MP RVU 0.81) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT codes 21555 and 21556?

CPT 21555 is used for excision of subcutaneous neck lesions measuring less than 3 centimeters, while 21556 covers lesions 3 centimeters or larger. The size distinction is critical as 21556 reimburses at a higher rate ($559.67 non-facility) compared to 21555 ($422.77 non-facility), making accurate pre-excision measurement documentation essential.

Can I bill an E/M visit on the same day as CPT 21555?

Yes, you can bill a separate E/M service with CPT 21555 on the same day if the E/M represents a significant, separately identifiable service beyond the normal pre-procedure assessment. You must append modifier 25 to the E/M code and document a distinct reason for the visit, such as initial evaluation and decision for surgery or management of unrelated conditions.

What documentation is required to support medical necessity for CPT 21555?

Documentation must include the clinical indication for excision such as patient symptoms (pain, tenderness, discharge), evidence of lesion growth or change, concern for malignancy based on clinical appearance or imaging, functional impairment, or recurrent infection. Pathology submission is expected, and purely cosmetic indications will typically be denied by Medicare and most commercial payers.

How do I bill for multiple neck lesion excisions performed during the same session?

Bill CPT 21555 for the first/largest lesion at full rate, then bill 21555 again for each additional lesion with modifier 59 appended to indicate distinct procedural service. Medicare typically pays subsequent lesions at 50% of the allowed amount. Ensure each lesion is documented separately with individual size, location, and pathology specimen labeling.

What specialty physicians typically perform and bill CPT code 21555?

CPT 21555 is most commonly billed by general surgeons, otolaryngologists (ENT), plastic surgeons, and head and neck surgeons. Dermatologic surgeons may also perform this procedure when lesions extend to subcutaneous depth. The procedure can be performed in office surgical suites, ambulatory surgery centers, or hospital outpatient departments.

Does CPT 21555 include pathology examination of the excised lesion?

No, CPT 21555 covers only the surgical excision procedure. Pathology examination must be billed separately using appropriate pathology CPT codes (typically 88304 for gross and microscopic examination of a cyst or lipoma, or 88305 for more complex specimens). The surgical code's reimbursement does not include the pathology professional or technical components.