CPT 24079Surgery

Rad rescj tum tiss a/e 5 cm+

CPT code 24079 covers the surgical removal of large tumors (5 centimeters or larger) from soft tissue in the arm or elbow area. This is a major surgical procedure requiring complete removal of the tumor and surrounding tissue.

Showing rates for

National Average

Base Medicare rate

$1,300.65

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

20.61

PE RVU (NF)

14.89

MP RVU

4.71

Total RVU

40.21

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 measurements from imaging and pathology reports; size must be clearly 5cm or greater to support 24079 versus 24077
Impact: $390.20 difference between 24079 ($1300.65) and 24077 for smaller tumors; critical threshold documentation
Verify non-facility vs facility setting coding; 24079 has identical rates ($1300.65) for both settings, but documentation requirements differ
Impact: Prevents setting-specific denials; ensures proper place of service coding
Include frozen section pathology results and final pathology confirming tumor type and margins in claim documentation
Impact: Reduces medical necessity denials by 60-70%; supports oncologic indication requirement
Do not unbundle separately billable reconstruction codes without modifier 59; complex closures are typically included in 24079
Impact: Avoid $200-500 in bundling recoupments; major reconstructions (flaps, grafts) may be separately billable with documentation
Bill preoperative MRI and biopsy separately with appropriate timing; ensure biopsy is at least 2 weeks prior to definitive resection
Impact: Additional $300-800 in legitimate separate reimbursement for diagnostic workup
For tumors involving neurovascular exploration or repair, document separately and consider modifier 22 rather than unbundling nerve/vessel codes
Impact: Modifier 22 approach typically yields 25-40% payment increase ($325-520) versus denial risk from unbundling

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 24079 in 2025?

The 2025 Medicare national average reimbursement for CPT 24079 is $1300.65 for both facility and non-facility settings, based on 40.21 total RVUs and the 2025 conversion factor of 32.3465.

What is the difference between CPT 24077 and 24079?

CPT 24077 is for radical resection of arm/elbow soft tissue tumors less than 5cm, while 24079 is for tumors 5cm or greater. The size threshold of 5cm determines which code to use, with 24079 valued significantly higher due to increased complexity.

Can I bill CPT 24079 with a reconstruction code?

Simple and intermediate closures are included in 24079. Complex reconstructions such as flaps (e.g., 15734) or grafts (15240) may be separately billable with modifier 59 if the operative report clearly documents a distinct, complex reconstruction beyond typical closure.

What documentation is required to support CPT 24079?

Required documentation includes tumor size measurements ≥5cm from imaging and/or pathology, pathology confirming tumor type, anatomic location (arm/elbow), depth (subcutaneous/subfascial), margin assessment, structures resected, and medical necessity for radical resection rather than simple excision.

How many RVUs is CPT 24079 worth in 2025?

CPT 24079 has 40.21 total RVUs in 2025, comprising 20.61 work RVUs, 14.89 practice expense RVUs, and 4.71 malpractice RVUs. Both facility and non-facility PE RVUs are identical at 14.89.

What modifiers are most commonly used with CPT 24079?

Most common modifiers include RT/LT for laterality (required), modifier 22 for increased complexity when neurovascular involvement or extensive resection is documented, and modifier 58 for staged procedures such as planned re-excision for margin clearance.

Is CPT 24079 subject to the multiple procedure payment reduction?

Yes, when 24079 is performed with other procedures, modifier 51 applies and secondary procedures receive 50% payment reduction. However, 24079 is typically the primary procedure due to its high RVU value (40.21) and should be listed first to receive full payment.