CPT 21558Surgery

Resect neck tumor 5 cm/>

CPT code 21558 covers the surgical removal of a large neck tumor measuring 5 centimeters (about 2 inches) or greater. This is a complex procedure requiring significant surgical skill to remove substantial growths in the delicate neck area.

Showing rates for

National Average

Base Medicare rate

$1,308.42

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

21.58

PE RVU (NF)

14.31

MP RVU

4.56

Total RVU

40.45

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

NCCI bundling edits

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Billing tips

Measure and document tumor size intraoperatively in three dimensions with largest dimension clearly stated in operative note
Impact: Failure to document 5 cm minimum can result in downcoding to 21555 ($807.32), a loss of $501.10 per case
Bill in non-facility setting when performed in ASC or hospital outpatient department to capture full $1308.42 rate
Impact: Both facility and non-facility rates are identical at $1308.42, but verify payer-specific policies as some commercial payers may have different fee schedules
When reconstruction is required, bill separately using appropriate flap codes (15730-15738) or skin graft codes with modifier 59
Impact: Can add $500-$2000+ in additional reimbursement depending on complexity of reconstruction; ensure documentation supports separate procedure
For tumors involving both superficial and deep compartments, document depth and relationship to critical structures to support modifier 22
Impact: Successful modifier 22 appeal can increase payment by $260-$390 with comprehensive documentation of additional work
Submit pathology report with claim when dealing with potential denials or audits to confirm tumor size and nature
Impact: Reduces denial rate by approximately 15-20% and expedites payment by providing immediate verification of medical necessity
Verify global period (090 days) and avoid billing separately for routine postoperative care within the global window
Impact: Prevents automatic denials and audit flags; unrelated E/M services require modifier 24 and clear documentation of separate condition

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 21558 in 2025?

The 2025 Medicare national average reimbursement for CPT 21558 is $1308.42 for both facility and non-facility settings, based on 40.45 total RVUs and the conversion factor of 32.3465.

What size tumor qualifies for CPT code 21558?

CPT 21558 requires the neck tumor to measure 5 centimeters (approximately 2 inches) or greater in its largest dimension. Tumors smaller than 5 cm should be coded with 21555 (2.5-5 cm) or 21552 (less than 2.5 cm).

Can CPT 21558 be billed with a neck dissection code?

Yes, but modifier 59 is typically required to indicate the tumor resection is a distinct procedure from the lymph node dissection. Documentation must clearly show the procedures were performed in separate anatomic areas or through different surgical approaches to avoid bundling denials.

How many RVUs is CPT code 21558 worth?

CPT 21558 has 40.45 total RVUs in 2025, consisting of 21.58 work RVUs, 14.31 practice expense RVUs, and 4.56 malpractice RVUs. This reflects the high complexity and risk of large neck tumor resection.

What documentation is needed to support medical necessity for CPT 21558?

Required documentation includes preoperative imaging showing tumor size and location, clinical notes documenting symptoms or indications for surgery, operative note with detailed measurements and technique, and pathology report confirming tumor type and dimensions of 5 cm or greater.

What is the global period for CPT 21558?

CPT 21558 has a 090-day global surgical period, meaning routine postoperative care for 90 days after surgery is included in the reimbursement and cannot be billed separately unless complications arise or unrelated services are provided with appropriate modifiers.

What specialties typically bill CPT code 21558?

CPT 21558 is most commonly billed by otolaryngologists (ENT surgeons), head and neck surgeons, surgical oncologists, and general surgeons with head and neck expertise. The procedure requires advanced surgical skills and hospital privileges for complex cervical procedures.