CPT 24076Surgery

Ex arm/elbow tum deep < 5 cm

CPT 24076 covers the surgical removal of a deep tumor or abnormal growth in the arm or elbow area that measures less than 5 centimeters. This is a more complex procedure than superficial tumor removal because it involves deeper tissue layers including muscle and fascia.

Showing rates for

National Average

Base Medicare rate

$543.42

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

7.41

PE RVU (NF)

7.85

MP RVU

1.54

Total RVU

16.8

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

NCCI bundling edits

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Billing tips

Ensure operative note explicitly documents tumor depth as subfascial or intramuscular with specific measurement under 5cm; vague descriptions risk downcoding to 24071 (superficial <3cm, $328.46) or 24073 (superficial >3cm, $419.29)
Impact: Proper documentation preserves $124.13-$214.96 in reimbursement versus superficial codes
If tumor measures 5cm or greater, code 24077 should be used instead; this pays $780.92, which is $237.50 more than 24076; verify final pathology measurement matches operative documentation
Impact: Accurate size documentation ensures correct code selection and prevents $237.50 undercoding
Submit pathology report with claim showing deep tissue origin and confirming size; many payers require this for payment, especially Medicare contractors
Impact: Reduces initial denial rate by approximately 35-40% and accelerates first-pass payment
Code separately for complex closure (13120-13122) only if closure required extensive undermining beyond normal layered closure; simple layered closure is included in 24076
Impact: Appropriate complex closure coding adds $154-$310 when documented with wound length and complexity justification
When neurovascular dissection significantly increases complexity, consider modifier 22 with comparative documentation showing why this case exceeded typical work
Impact: Successful modifier 22 appeals can add $108-$217 but require detailed operative dictation and peer review support
Do not unbundle intraoperative frozen section (88331) as this is part of the surgical decision-making; only final pathology evaluation is separately billable by the pathologist

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 24076 in 2025?

The 2025 Medicare national average reimbursement for CPT 24076 is $543.42 for both facility and non-facility settings. This rate is based on a total RVU of 16.8 multiplied by the conversion factor of 32.3465. Actual payment may vary by MAC jurisdiction and geographic adjustment.

What is the difference between CPT 24076 and 24077?

CPT 24076 is for deep tumor excision of the arm/elbow measuring less than 5 cm (pays $543.42), while 24077 is for tumors 5 cm or greater (pays $780.92). The size threshold is critical and must be measured in situ before excision. Code selection is based on the largest dimension of the tumor clinically measured during surgery.

Can CPT 24076 be billed with an E/M service on the same day?

Generally no, unless the E/M service is significant and separately identifiable beyond the normal pre-operative assessment. If the decision for surgery is made on the same day and a distinct E/M occurs, modifier 25 may be appended to the E/M code, but documentation must clearly demonstrate services beyond surgical planning. Most same-day evaluations are considered part of the surgical package.

What diagnosis codes are appropriate for billing CPT 24076?

Appropriate ICD-10 codes include D17.2- (benign lipomatous neoplasm of limb), D21.1- (benign neoplasm of connective tissue of upper limb), C49.1- (malignant neoplasm of connective tissue of upper limb), D48.1 (neoplasm of uncertain behavior), or M79.89 (other specified soft tissue disorder). The specific code should match pathology findings and preoperative clinical diagnosis.

How do I bill CPT 24076 if the tumor is found to be superficial during surgery?

If intraoperative findings reveal the tumor is actually superficial (above the fascia), you must code based on actual findings: use 24071 for superficial tumors <3cm or 24073 for superficial tumors ≥3cm. Preoperative imaging showing deep location does not justify coding 24076 if surgical findings demonstrate superficial location. Code based on surgical reality, not preoperative impression.

What is the work RVU for CPT code 24076?

The work RVU for CPT 24076 is 7.41, which reflects the physician's time, technical skill, physical effort, mental effort, and stress associated with the procedure. The total RVU is 16.8, which includes work RVU (7.41), practice expense RVU (7.85), and malpractice RVU (1.54).

Do I need modifier 50 for bilateral arm tumor excisions?

Yes, if you remove deep tumors from both arms during the same operative session, append modifier 50 to indicate a bilateral procedure. Most payers reimburse bilateral procedures at 150% of the allowable rather than 200%, so expect approximately $815.13 total rather than the full doubled amount. Check individual payer policies as some require separate line items with LT/RT modifiers instead.