CPT 24077Surgery

Rad rescj tum tiss a/e <5cm

CPT code 24077 covers the surgical removal of a cancerous or aggressive tumor from the soft tissue of the arm or elbow area when the tumor measures less than 5 centimeters. This is a radical resection, meaning the surgeon removes the tumor along with a margin of surrounding healthy tissue to ensure complete removal.

Showing rates for

National Average

Base Medicare rate

$1,006.62

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)

11.86

MP RVU

3.54

Total RVU

31.12

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 with intraoperative measurement, not just preoperative imaging, as size determines code selection between 24071 (<3cm), 24073 (3cm+), and 24076/24077 (radical resection <5cm vs 5cm+)
Impact: Incorrect size documentation can result in $400-800 undercoding or overcoding; 24077 pays $1006.62 vs 24076 at higher rate for 5cm+ tumors
Clearly document radical resection technique including fascial excision, muscle compartment involvement, and margin assessment to differentiate from simple excision codes (24065-24066) which pay significantly less
Impact: Simple excision codes reimburse $200-400 compared to $1006.62 for 24077; radical resection requires documentation of wide margins and fascial/muscle involvement
Bill reconstruction separately with appropriate codes (e.g., 15734-15738 for muscle flaps, 20926 for tissue grafts) as these are not bundled with radical resection
Impact: Complex closures and reconstructions can add $500-2000+ when properly documented and coded with modifier 51 or 59 as distinct procedural service
Obtain pathology confirmation of tumor type and margin status within 48-72 hours; include path report with claim for high-value cases to reduce audit risk
Impact: Preemptive documentation reduces denial rate by 30-40% for high-RVU oncology codes and supports medical necessity
Verify precertification requirements for tumor resections with commercial payers before surgery; many require pre-auth for procedures over $1000
Impact: Lack of pre-authorization can result in complete denial of $1006.62 payment; 15-20% of high-cost procedure denials relate to authorization issues

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 24077 in 2025?

The 2025 Medicare national average reimbursement for CPT 24077 is $1006.62 for both facility and non-facility settings. This rate is based on 31.12 total RVUs (15.72 work RVU, 11.86 PE RVU, 3.54 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 24077 and 24076?

CPT 24077 is for radical resection of arm/elbow soft tissue tumors less than 5cm, while 24076 covers tumors 5cm or greater. The tumor size at greatest dimension determines which code to use, and this must be documented with intraoperative measurements. Code selection significantly impacts reimbursement as 24076 typically has higher RVUs due to increased surgical complexity.

Can I bill CPT 24077 with a reconstruction code?

Yes, reconstruction procedures (such as muscle flaps 15734-15738, skin grafts 15100-15121, or tissue rearrangement 14000-14302) are separately reportable with CPT 24077. Use modifier 51 or 59 on the reconstruction code to indicate a distinct procedural service, and ensure operative documentation clearly describes both the tumor resection and the separate reconstruction procedure.

What diagnosis codes support medical necessity for CPT 24077?

Primary diagnoses supporting 24077 include malignant soft tissue neoplasms (C49.1x for upper limb connective tissue), specific sarcoma codes (liposarcoma, synovial sarcoma, fibrosarcoma), and aggressive benign tumors requiring radical resection. ICD-10 codes must specify exact anatomic location (shoulder, upper arm, elbow, forearm) and laterality to support the procedure's medical necessity.

How do I document tumor size for CPT 24077 billing?

Document tumor size in three dimensions from both preoperative imaging (MRI preferred) and intraoperative direct measurement at greatest dimension. The operative note should state the measured size after excision, confirm it is less than 5cm, and describe the depth (subfascial/intramuscular). Final pathology report should corroborate size measurements to support code selection and reduce audit risk.

What modifiers are most commonly used with CPT 24077?

The most common modifiers for 24077 are: LT/RT for laterality (required), modifier 22 for significantly increased complexity with documented additional work, modifier 58 for staged procedures or planned re-excision within global period, and modifier 59 or XS when billing separately identifiable procedures on the same date. Modifier 51 applies when multiple procedures are performed together.

Is CPT 24077 subject to the Medicare global surgical package?

Yes, CPT 24077 has a 90-day global period under Medicare rules. This includes preoperative evaluation (typically 1 day before), the surgical procedure, and all routine postoperative care for 90 days. Complications requiring return to OR use modifier 78, while unrelated E/M services during the global period require modifier 24. Staged procedures planned at initial surgery use modifier 58.