CPT 21602Surgery

Exc ch wal tum w/o lymphadec

CPT code 21602 covers the surgical removal of a tumor from the chest wall without removing nearby lymph nodes. This is a major surgical procedure typically performed for benign or malignant tumors affecting the ribs, sternum, or chest wall soft tissues.

Showing rates for

National Average

Base Medicare rate

$1,502.82

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

22.19

PE RVU (NF)

18.92

MP RVU

5.35

Total RVU

46.46

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

NCCI bundling edits

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Billing tips

Document tumor size in three dimensions, exact anatomical location (specific ribs/sternum involved), and depth of invasion to justify medical necessity
Impact: Prevents medical necessity denials which account for 35-40% of initial rejections; supporting pathology reports are essential
Use modifier 22 with detailed operative note when resection requires chest wall reconstruction, extensive rib resection (>3 ribs), or sternal involvement
Impact: Can increase reimbursement by $300-450 beyond base $1502.82 rate; requires comparative statement documenting 25%+ additional work
Separately bill chest wall reconstruction codes (21740-21743) with modifier 59 when performed as distinct procedure from tumor excision
Impact: Additional $800-2000 reimbursement depending on reconstruction complexity; clear documentation of separate incision/approach strengthens claim
Verify pre-authorization requirements for non-Medicare payers, as many require prior approval for chest wall tumor excision
Impact: Prevents complete claim denial; 60% of commercial payers require pre-auth for this code with 10-14 day processing time
Include pathology report confirmation of tumor diagnosis with claim submission for expedited processing
Impact: Reduces medical review delays by 40-50%; frozen section and permanent pathology both support medical necessity
Document negative margins and margin width in operative note and pathology report to support extent of resection billed
Impact: Supports modifier 22 consideration and prevents downcoding to less extensive excision codes; margin status affects global surgical appropriateness

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Frequently asked questions

What is the 2025 Medicare reimbursement rate for CPT code 21602?

The 2025 Medicare national average reimbursement rate for CPT 21602 is $1502.82 for both facility and non-facility settings. This is based on a total RVU of 46.46 and a conversion factor of 32.3465. Actual reimbursement may vary by geographic location based on local Medicare Administrative Contractor (MAC) adjustments.

What is the difference between CPT 21602 and 21603?

CPT 21602 is excision of chest wall tumor WITHOUT mediastinal lymphadenectomy, while CPT 21603 includes mediastinal lymphadenectomy as part of the procedure. Code 21603 has higher RVUs and reimbursement due to the additional complexity of lymph node dissection. Documentation must clearly state whether lymph nodes were removed to select the correct code.

Can CPT 21602 be billed with chest wall reconstruction codes?

Yes, CPT 21602 can be billed with chest wall reconstruction codes (21740-21743) when reconstruction is performed as a distinct, separately identifiable procedure. Use modifier 59 on the reconstruction code to indicate it is a separate procedure. Documentation must clearly support the medical necessity of both tumor excision and reconstruction with detailed operative notes describing each component.

What documentation is required to bill CPT 21602?

Required documentation includes: pre-operative imaging showing tumor location and size, detailed operative report with tumor dimensions (3 planes), specific anatomical structures involved, confirmation that lymphadenectomy was not performed, margin status, and pathology report confirming neoplastic diagnosis. Documentation must clearly distinguish this from simpler excision procedures and support medical necessity.

How many RVUs is CPT code 21602 worth in 2025?

CPT 21602 has a total of 46.46 RVUs in 2025, composed of 22.19 work RVUs, 18.92 practice expense RVUs (both facility and non-facility), and 5.35 malpractice RVUs. This is considered a high-value surgical code reflecting the complexity and risk of chest wall tumor excision.

What specialties typically bill CPT code 21602?

CPT 21602 is primarily billed by thoracic surgeons, surgical oncologists, and cardiothoracic surgeons. General surgeons with thoracic training and orthopedic oncologists also bill this code for chest wall tumor excisions. The procedure requires specialized training in thoracic surgery and is typically performed in hospital settings.

Is prior authorization required for CPT 21602?

Prior authorization requirements vary by payer. Medicare typically does not require prior authorization for CPT 21602, but approximately 60% of commercial insurance plans do require pre-authorization for chest wall tumor excision. Always verify payer-specific requirements before scheduling surgery to avoid claim denials. Authorization processing typically takes 10-14 business days.