CPT 24073Surgery

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CPT code 24073 is used when a surgeon removes a deep tumor or abnormal growth from the arm or elbow area that measures 5 centimeters or larger. This is a complex surgical procedure that involves cutting through multiple layers of tissue to access and remove the mass.

Showing rates for

National Average

Base Medicare rate

$685.10

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

10.13

PE RVU (NF)

8.81

MP RVU

2.24

Total RVU

21.18

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

NCCI bundling edits

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Billing tips

Measure and document tumor size in three dimensions with exact measurements in operative report; CPT 24073 requires ≥5cm threshold versus 24071 (<5cm). Include ruler measurements or imaging correlation.
Impact: Prevents downcoding to 24071 ($490.87, 14.75 RVUs) - potential loss of $194.23 per case if size documentation inadequate
Explicitly document tumor depth relative to fascia (subfascial/intramuscular) in operative note; specify muscle compartments entered and anatomical planes dissected
Impact: Differentiates from superficial excision codes (24071/24075); inadequate depth documentation risks denial or reduction of $200-300 per claim
Obtain and document pathology report confirming tumor size, margins, and tissue diagnosis; ensure pathology measurements align with operative measurements
Impact: Provides objective verification for audits; correlation between surgical and pathology measurements reduces audit risk by 60-70%
When margins are inadequate and re-excision planned, bill initial excision with modifier 58 for staged procedure rather than unbundled separate codes
Impact: Maintains compliance while allowing separate payment; incorrect coding could trigger recoupment of entire $685.10 payment
For complex cases requiring vascular or nerve reconstruction, bill appropriate repair codes separately (35206, 64834-64876) with modifier 59 and comprehensive documentation
Impact: Can add $500-2,000 in legitimate additional reimbursement when medically necessary and properly documented
Submit preauthorization with imaging studies (MRI preferred) showing tumor location, size, and depth before scheduled surgery for high-cost cases

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 24073 in 2025?

The 2025 Medicare national average reimbursement for CPT 24073 is $685.10 for both facility and non-facility settings. This rate is based on 21.18 total RVUs (10.13 work RVU, 8.81 PE RVU, 2.24 MP RVU) multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on GPCI adjustments.

What is the difference between CPT codes 24071 and 24073?

The primary difference is tumor size: CPT 24071 is for deep arm/elbow tumors less than 5cm, while 24073 is for tumors 5cm or greater. Both require subfascial/intramuscular depth. The reimbursement difference is significant - 24073 pays $685.10 (21.18 RVUs) versus 24071 at approximately $490.87 (14.75 RVUs). Accurate measurement documentation in the operative report is critical for correct code selection.

Does CPT 24073 require preauthorization from insurance?

Most commercial payers and Medicare Advantage plans require preauthorization for CPT 24073 due to the surgical nature and reimbursement level. Traditional Medicare typically does not require prior authorization but does require medical necessity documentation. Submit preoperative imaging (MRI/CT) and clinical notes with authorization requests. Verify specific payer requirements 7-10 days before scheduled surgery to avoid denials.

Can CPT 24073 be billed with complex wound closure codes?

No, routine layered closure is included in CPT 24073 and cannot be separately billed. However, if the excision creates a defect requiring complex reconstruction beyond typical closure (such as advancement flap, rotational flap, or skin graft codes 14000-14350 or 15100-15261), these may be separately reportable with modifier 59 and comprehensive documentation explaining why reconstruction was necessary beyond standard closure technique.

How should tumor size be documented for CPT 24073 billing?

Document tumor size in three dimensions (length x width x depth in centimeters) in the operative report, measuring the fresh specimen with a ruler. At minimum, one dimension must be ≥5cm for code 24073. Also reference preoperative imaging measurements for correlation. Note that pathology measurements may show 10-15% shrinkage due to fixation; explain any discrepancy in your documentation. Both operative and pathology measurements should support the ≥5cm threshold.

What documentation proves the tumor is deep enough for CPT 24073 versus superficial codes?

The operative report must explicitly state the tumor is subfascial or intramuscular, naming specific muscle compartments accessed (e.g., biceps, triceps, brachialis). Document dissection through fascia and into/through muscle. Avoid vague terms like 'deep tissue.' The pathology report should confirm tissue of origin (muscle, deep connective tissue). Preoperative MRI reports showing tumor location deep to fascia provide additional supporting documentation for audits.

Can CPT 24073 be billed bilaterally with modifier 50?

Yes, if bilateral arm/elbow tumor excisions are performed during the same operative session and both meet the ≥5cm deep tumor criteria, CPT 24073 can be billed with modifier 50 for bilateral procedure. This typically reimburses at 150% of the unilateral rate ($1,027.65 total). However, this scenario is clinically rare. Ensure separate documentation for each side with individual measurements, pathology specimens, and medical necessity justification for bilateral surgery.