Resect back tum < 5 cm

CPT code 21935 covers the surgical removal of a tumor from the back that measures less than 5 centimeters in diameter. This includes cutting out the abnormal growth and preparing the tissue for examination.

Showing rates for

National Average

Base Medicare rate

$997.24

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

15.72

PE RVU (NF)

11.46

MP RVU

3.65

Total RVU

30.83

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

NCCI bundling edits

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Billing tips

Document exact tumor dimensions in three planes (length x width x depth) measured intraoperatively with ruler, not just estimated size; CPT 21935 is strictly for tumors <5cm in any dimension
Impact: Prevents downcoding or denial; undocumented size triggers automatic medical review. If tumor measures ≥5cm, code shifts to 21936 with reimbursement of $1,432.89, a $435.65 difference
Specify tissue plane of origin (subcutaneous, subfascial, intramuscular) and depth from skin surface in operative note; superficial skin lesions should use integumentary codes (11400-11406 series)
Impact: Prevents $800+ downcoding to simple excision codes; auditors look for documentation of deep dissection below dermis/superficial fascia to justify 21935
Submit pathology report with claim or ensure it's available in medical record; histologic confirmation supports medical necessity and rules out simple lipoma requiring different coding
Impact: Reduces denial rate by 40-60% for tumor excisions; many payers require pathology correlation within 30 days of claim submission for complex resections
For malignant tumors, append appropriate diagnosis codes from C49.6 (malignant neoplasm of connective tissue of trunk) series and document oncologic margins
Impact: Supports medical necessity for more extensive resection and potential modifier 22; facilitates prior authorization and reduces utilization review denials
When performed in ASC setting, verify 21935 is on facility's approved procedure list and patient meets ASC criteria; some payers restrict based on tumor characteristics
Impact: Both physician and facility receive same rate ($997.24) for 21935, but ASC claim denials for unauthorized procedures can delay entire reimbursement cycle 60+ days

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Frequently asked questions

What is the CPT code 21935 used for?

CPT 21935 is used for surgical resection of a soft tissue tumor located on the back or flank region that measures less than 5 centimeters in its largest dimension. This includes removal of tumors from subcutaneous tissue, fascia, or muscle, but excludes simple skin lesion removal which uses different codes.

How much does Medicare pay for CPT 21935 in 2025?

Medicare pays $997.24 for CPT 21935 in 2025 based on the national average rate. This rate applies to both facility and non-facility settings. The code has 30.83 total RVUs (15.72 work RVUs, 11.46 practice expense RVUs, and 3.65 malpractice RVUs) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 21935 and 21936?

The difference is tumor size: CPT 21935 is for back tumors less than 5 centimeters, while CPT 21936 is for tumors 5 centimeters or larger. The size must be measured intraoperatively at the time of resection. Using the wrong code based on tumor size can result in significant reimbursement differences, as 21936 pays approximately $435 more than 21935.

Can CPT 21935 be billed with an office visit on the same day?

Yes, but only if the evaluation and management service is separately identifiable from the surgical procedure and modifier 25 is appended to the E/M code. The documentation must clearly show a distinct service beyond the typical pre-operative assessment, such as evaluation of an unrelated condition or a significant separately identifiable evaluation that led to the decision for surgery.

Does CPT 21935 include wound closure?

Yes, CPT 21935 includes routine layered closure as part of the global surgical package. Intermediate or complex closure codes (12031-12057) should not be separately billed. Only reconstructive procedures significantly beyond standard closure, such as advancement flaps or grafts, may warrant separate coding with appropriate modifiers.

What diagnosis codes are typically used with CPT 21935?

Common diagnosis codes include D21.2 (benign neoplasm of connective tissue of trunk), C49.6 (malignant neoplasm of connective tissue of trunk), D48.1 (neoplasm of uncertain behavior), or M79.89 (other specified soft tissue disorders). The specific ICD-10 code depends on pathology results and tumor characteristics documented in pre-operative imaging and clinical evaluation.

What is the global period for CPT 21935?

CPT 21935 has a 90-day global surgical period. This means routine post-operative care for 90 days after the procedure is included in the reimbursement and should not be separately billed. Complications requiring return to the operating room, unrelated E/M services, or treatment outside the normal recovery course may be separately billable with appropriate modifiers.