{"id":176250,"date":"2026-08-12T11:22:42","date_gmt":"2026-08-12T11:22:42","guid":{"rendered":"https:\/\/pabau.com\/?p=176250"},"modified":"2026-08-12T14:21:38","modified_gmt":"2026-08-12T14:21:38","slug":"cpt-code-21925","status":"publish","type":"post","link":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21925\/","title":{"rendered":"CPT code 21925: Deep soft tissue biopsy of the back or flank"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"CPT code 21925: Deep soft tissue biopsy of the back or flank\",\"description\":\"CPT code 21925 (Biopsy, soft tissue of back or flank; deep) billing reference covering 2026 RVU values, Medicare rates, the 090 global period, modifiers, ICD-10 pairing, and documentation requirements.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21925\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-01-15\",\"dateModified\":\"2026-08-12\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>CPT code 21925 covers a deep biopsy of soft tissue in the back or flank. It is a biopsy, so the lesion stays in the patient.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Medicare assigns 21925 a 090 global period, which treats a diagnostic biopsy as major surgery with 90 days of included follow-up.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>The 2026 national payment is about $543 in a practice and about $373 in a facility, from total RVUs of 16.26 and 11.16.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Work RVU is 4.51, and depth wording is the only thing separating 21925 from 21920. A downcode to 21920 costs roughly $279.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Practice management software like Pabau ties the depth wording in the procedure note to the code on the claim, so fewer claims come back.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">CPT code 21925 is a deep biopsy of soft tissue in the back or flank. It sits in the Musculoskeletal System chapter of the CPT code set, which the <a href=\"https:\/\/www.ama-assn.org\/practice-management\/cpt\/cpt-code-set-overview\" target=\"_blank\" rel=\"nofollow noopener\">American Medical Association (AMA)<\/a> maintains. A specimen goes to pathology, and the mass itself stays in the patient.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">One detail trips billers up. Medicare treats 21925 as major surgery with a 090 global period, even though nothing is removed. That means 90 days of bundled postoperative care on a diagnostic procedure. It also changes which E\/M modifier belongs on the visit that led to the biopsy.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Field<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Detail<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">CPT code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">21925<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Short descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Biopsy soft tiss back\/flank deep<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Long descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Biopsy, soft tissue of back or flank; deep<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Procedure type<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Open diagnostic biopsy, not an excision. The lesion remains in place<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">CPT section<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Excision Procedures on the Back and Flank (21920-21936)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Global period<\/td>\n<td style=\"padding:12px 16px;color:#374151\">090, a 90-day major surgical global<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Total RVUs (2026)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">16.26 non-facility, 11.16 facility<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">2026 national payment<\/td>\n<td style=\"padding:12px 16px;color:#374151\">About $543 non-facility, about $373 facility<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code status<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Active for 2026<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Performing specialties<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Orthopedic surgery, general surgery, oncology, dermatology<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Orthopedic surgeons, general surgeons, and oncologists are the primary users of this code. It comes up when a palpable mass in the back or flank needs histology before a treatment plan can be set. <a href=\"https:\/\/pabau.com\/industry\/dermatology-emr-software\/\" rel=\"noopener\">Dermatology billing teams<\/a> also see it where soft tissue tumors of uncertain behavior are under evaluation.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"CPT Coding Pitfalls Every Medical Practice Faces\" width=\"800\" height=\"450\" src=\"https:\/\/www.youtube.com\/embed\/vbvV5okdXKg?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 id=\"h-procedure-description-what-cpt-21925-covers\" class=\"wp-block-heading\">Procedure description: What CPT 21925 covers<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT 21925 covers an open incision through skin and subcutaneous fat to reach deeper soft tissue, where a specimen is taken. Depth is what separates this code from its superficial counterpart, 21920. It also drives the clinical complexity and the payment attached to the code.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This is not an excision code. If the surgeon removes the whole lesion, the correct code sits in the 21930 to 21936 range instead. That choice turns on depth, size, and whether the resection was radical. Reporting an excision code for a biopsy is upcoding.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Incision and dissection:<\/strong> The surgeon opens the skin and separates subcutaneous tissue to reach the deeper fascial or muscular plane.<\/li>\n\n\n\n<li><strong>Tissue sampling:<\/strong> A specimen is taken from the deeper layer, typically muscle, fascia, or an identifiable mass below the subcutaneous fat.<\/li>\n\n\n\n<li><strong>Lesion left in place:<\/strong> Only a sample is removed. The mass remains in situ pending the pathology result and any later treatment decision.<\/li>\n\n\n\n<li><strong>Anatomical region:<\/strong> Restricted to the back or flank. Adjacent regions such as the extremities and abdomen have separate code sets.<\/li>\n\n\n\n<li><strong>Closure:<\/strong> The wound is closed in layers. Local or general anesthesia is used depending on depth and patient factors.<\/li>\n\n\n\n<li><strong>Specimen handling:<\/strong> The specimen goes for pathological analysis, and documentation must link the biopsy to the resulting pathology report.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pabau.com\/industry\/plastic-surgery-emr\/\" rel=\"noopener\">Plastic surgery practices<\/a> and musculoskeletal teams use it when imaging suggests a deep-seated lesion that needs a histological diagnosis first. It does not cover needle biopsies. Percutaneous needle sampling of muscle is CPT 20206.<\/p>\n\n\n\n<h2 id=\"h-cpt-21920-vs-cpt-21925-superficial-vs-deep-biopsy\" class=\"wp-block-heading\">CPT 21920 vs CPT 21925: Superficial vs deep biopsy<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The depth of tissue accessed is the only differentiator between these two codes, and it is worth about $279 a claim. Payers downcode to 21920 when the operative note does not confirm dissection below the subcutaneous layer. The two codes also carry different global periods.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Factor<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">CPT 21920 (superficial)<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">CPT 21925 (deep)<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Biopsy, soft tissue of back or flank; superficial<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Biopsy, soft tissue of back or flank; deep<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Tissue depth<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Subcutaneous layer only<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Below subcutaneous; fascia, muscle, or deep mass<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Typical clinical scenario<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Subcutaneous nodule or superficial soft tissue lesion<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Deep soft tissue tumor, intramuscular mass, suspected sarcoma<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Anesthesia<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Usually local only<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Local or general depending on depth and patient tolerance<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Work RVU (2026)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">2.06<\/td>\n<td style=\"padding:12px 16px;color:#374151\">4.51<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Total RVU (non-facility)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">7.90<\/td>\n<td style=\"padding:12px 16px;color:#374151\">16.26<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Total RVU (facility)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">4.26<\/td>\n<td style=\"padding:12px 16px;color:#374151\">11.16<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Medicare non-facility rate<\/td>\n<td style=\"padding:12px 16px;color:#374151\">About $264<\/td>\n<td style=\"padding:12px 16px;color:#374151\">About $543<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Global period<\/td>\n<td style=\"padding:12px 16px;color:#374151\">010, a 10-day minor procedure global<\/td>\n<td style=\"padding:12px 16px;color:#374151\">090, a 90-day major surgical global<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Documentation key<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Depth confirmed as subcutaneous<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Depth below subcutaneous stated explicitly<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The global period difference matters as much as the money. Choosing 21925 commits your practice to a 90-day postoperative window instead of a 10-day one. So treat the depth qualifier in the operative note as mandatory, not as a nice-to-have.<\/p>\n\n\n\n<h2 id=\"h-rvu-values-and-the-2026-conversion-factor\" class=\"wp-block-heading\">RVU values and the 2026 conversion factor<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The figures below come from the CMS RVU26A file, the relative value file for the 2026 physician fee schedule. It applies to services furnished from January 1, 2026. CMS resets RVUs every year, so confirm current values in the <a href=\"https:\/\/www.cms.gov\/medicare\/payment\/fee-schedules\/physician\/pfs-relative-value-files\" target=\"_blank\" rel=\"nofollow noopener\">CMS relative value files<\/a> before you calculate expected payment.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">RVU component<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:center;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Value<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Notes<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Work RVU<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">4.51<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Reflects surgeon time, clinical intensity, and the 90-day follow-up<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Practice expense RVU (non-facility)<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">10.72<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Office setting; covers supplies, staff time, and overhead<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Practice expense RVU (facility)<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">5.62<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Hospital or ASC setting; the facility bills its own overhead<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Malpractice RVU<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">1.03<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Risk adjustment component<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Total RVU (non-facility)<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">16.26<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Basis for the office payment<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Total RVU (facility)<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">11.16<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Basis for the hospital outpatient or ASC payment<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Global period<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">090<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Major surgery; 90 days of routine postoperative care included<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Multiply total RVUs by the 2026 conversion factor of $33.4009 to reach the national amount before geographic adjustment. That works out at roughly $543 in a practice and $373 in a facility. Each annual fee schedule resets these numbers, so rerun the math every January.<\/p>\n\n\n\n<h2 id=\"h-medicare-reimbursement-by-place-of-service\" class=\"wp-block-heading\">Medicare reimbursement by place of service<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Payment for CPT 21925 depends on place of service. The non-facility rate is higher because the practice absorbs overhead that a hospital or surgery center would otherwise carry. Use the <a href=\"https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search\/overview\" target=\"_blank\" rel=\"nofollow noopener\">CMS Physician Fee Schedule lookup tool<\/a> to confirm the amount for your locality, since geographic adjustments apply.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Setting<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Place of service code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:center;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">2026 national average<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Notes<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Physician office<\/td>\n<td style=\"padding:12px 16px;color:#374151\">POS 11<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">About $543<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Non-facility rate; the larger practice expense component is included<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Hospital outpatient<\/td>\n<td style=\"padding:12px 16px;color:#374151\">POS 22<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">About $373<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Facility rate; the hospital bills its own payment under OPPS<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Ambulatory surgery center<\/td>\n<td style=\"padding:12px 16px;color:#374151\">POS 24<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">About $373<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Facility rate; the ASC bills its own facility fee separately<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The spread between the two rates is about $170 per case, which is why place of service is worth auditing. Both figures are national averages drawn from the 2026 fee schedule and will shift with your locality. Private payer rates are negotiated per contract and move independently of Medicare.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>In an ambulatory surgery center or hospital outpatient department, bill 21925 at the facility rate of about $373. The $543 non-facility rate does not apply, because the facility bills its own fee for the same encounter. Submitting the non-facility amount from POS 22 or POS 24 is a common trigger for overpayment demands.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-the-090-global-period-and-postoperative-billing\" class=\"wp-block-heading\">The 090 global period and postoperative billing<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT 21925 carries a 090 global period, which makes it a major surgical procedure under Medicare. Payment covers the day before the procedure, the biopsy itself, and 90 days of routine follow-up. Superficial biopsy code 21920 sits at 010 instead, so the two codes are governed by different rules.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>What the payment includes:<\/strong> The preoperative visit the day before, the biopsy, wound checks, suture removal, and routine follow-up through day 90.<\/li>\n\n\n\n<li><strong>Decision for surgery:<\/strong> An E\/M visit on the day of or the day before takes modifier 57. Modifier 25 belongs to minor procedures with a 000 or 010 global period, so it is the wrong choice here.<\/li>\n\n\n\n<li><strong>Unrelated care in the window:<\/strong> Use modifier 24 on an unrelated E\/M visit and modifier 79 on an unrelated procedure. The documentation must show the service had nothing to do with the biopsy.<\/li>\n\n\n\n<li><strong>Staged treatment:<\/strong> Modifier 58 covers a planned next step, such as excising the mass after a positive pathology result. Modifier 78 covers an unplanned return to the operating room for a complication.<\/li>\n\n\n\n<li><strong>Confirm the indicator:<\/strong> Global period assignments can change with an annual update. Check the current CMS relative value file before you bill any follow-up service. Assignments differ by code, so verify a neighbor like <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21750\/\" rel=\"noopener\">CPT 21750<\/a> separately.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">A 90-day window on a diagnostic code is easy to overlook. Billing a routine wound check on day 30 as a separate visit produces a clean denial, and a repeated pattern invites a review. The same window also affects surgeons who see the patient again once pathology comes back.<\/p>\n\n\n\n<h2 id=\"h-modifiers-that-belong-on-the-claim\" class=\"wp-block-heading\">Modifiers that belong on the claim<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Modifiers tell payers that unusual circumstances justify a service that might otherwise be bundled or denied. The ones below are the most common on 21925 claims outside the global window. Bundling rules change quarterly, so verify current NCCI edit status before you apply any modifier.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Modifier<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to apply<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-59<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Distinct procedural service<\/td>\n<td style=\"padding:12px 16px;color:#374151\">When 21925 is performed at a separate site or session from another procedure billed the same date; overrides NCCI bundling where the edit allows it<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-50<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Bilateral procedure<\/td>\n<td style=\"padding:12px 16px;color:#374151\">When biopsies are taken bilaterally, such as both flanks. Payer policies vary, and some require two lines with -LT and -RT instead<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-LT \/ -RT<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Left side \/ right side<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Laterality indicators for a procedure on one side; many payers prefer these over -50 on bilateral claims<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-22<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Increased procedural services<\/td>\n<td style=\"padding:12px 16px;color:#374151\">When the biopsy took substantially more work than typical. Expect to submit the operative note and a short explanation of the extra work<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-76<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Repeat procedure, same physician<\/td>\n<td style=\"padding:12px 16px;color:#374151\">When the same surgeon repeats 21925 on the same date for a different lesion or site; needs clear documentation of separate medical necessity<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-77<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Repeat procedure, different physician<\/td>\n<td style=\"padding:12px 16px;color:#374151\">When a different surgeon repeats the procedure on the same date; rare for biopsies but valid in specific circumstances<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Modifiers 57, 24, 58, 78, and 79 all relate to the 90-day global window, and the section above covers when each one applies. One modifier that does not belong on this code is -26. CPT 21925 has no professional and technical component split.<\/p>\n\n\n\n<h2 id=\"h-icd-10-cm-codes-that-support-medical-necessity\" class=\"wp-block-heading\">ICD-10-CM codes that support medical necessity<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medical necessity for CPT 21925 has to be supported by an appropriate ICD-10-CM diagnosis code. The diagnosis must show why a deep tissue biopsy of the back or flank was warranted. Codes are updated annually on October 1, so check the current fiscal year tabular list.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">ICD-10-CM code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Clinical scenario<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">D48.1<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Neoplasm of uncertain behavior of connective and other soft tissue<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Deep back or flank mass of unknown malignant potential; biopsy needed for classification<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">M79.89<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Other specified soft tissue disorders<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unspecified soft tissue mass in the back or flank requiring a diagnostic biopsy<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">D17.1<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Benign lipomatous neoplasm of skin and subcutaneous tissue of trunk<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Lipoma of the back or flank where benign nature has to be confirmed before any excision is planned<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">C79.89<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Secondary malignant neoplasm of other specified sites<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Deep back or flank mass in a patient with a known primary malignancy elsewhere; biopsy confirms metastatic disease<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">M54.5<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Low back pain (retired in FY2022, do not use)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">M54.5 was retired. Use M54.50, M54.51, or M54.59 depending on the presentation, and never submit a retired code<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">R22.2<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Localized swelling, mass and lump, trunk<\/td>\n<td style=\"padding:12px 16px;color:#374151\">First presentation of a palpable back or flank mass where the cause is unknown and biopsy is the next diagnostic step<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Specificity is where these claims fail. A trunk injury code such as <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-s21439d\/\" rel=\"noopener\">S21.439D<\/a> needs the right encounter character, and a retired code will never pay at all. Once pathology is back, bill the diagnosis the report supports rather than the pre-biopsy impression.<\/p>\n\n\n\n<h2 id=\"h-billing-guidelines-and-coding-rules\" class=\"wp-block-heading\">Billing guidelines and coding rules<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Several rules govern how CPT 21925 is submitted and paid. Bundling, authorization, and medical necessity account for most of the denials and post-payment audits on this code. The global period rules sit in their own section above.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>NCCI bundling edits:<\/strong> The National Correct Coding Initiative defines which codes cannot be billed together without a modifier. Check the current CMS NCCI tables before billing 21925 alongside another same-day procedure. The tables are reissued quarterly.<\/li>\n\n\n\n<li><strong>Biopsy taken during an excision:<\/strong> The biopsy generally bundles into the excision when the surgeon samples and removes the same lesion in one session. Report the excision code alone unless the biopsy addressed a separate lesion or a separate session.<\/li>\n\n\n\n<li><strong>Pre-authorization:<\/strong> Many commercial payers require prior authorization for soft tissue biopsies. Confirm requirements with each payer before scheduling. Medicare generally does not require it for 21925, though Medicare Advantage plans set their own rules.<\/li>\n\n\n\n<li><strong>Medical necessity:<\/strong> Documentation has to show why an open deep biopsy was needed rather than a less invasive approach. Payers may deny 21925 where a needle biopsy under CPT 20206 would have answered the same clinical question.<\/li>\n\n\n\n<li><strong>No component split:<\/strong> 21925 is a global surgical code with no professional and technical split. In a facility, bill the full code at the facility rate rather than appending modifier 26.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Bundling, authorization, and necessity rules repeat across the musculoskeletal chapter, so a code like <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21720\/\" rel=\"noopener\">CPT 21720<\/a> raises the same questions. Building those rules into the submission workflow removes the manual lookup at the point of billing.<\/p>\n\n\n\n<h2 id=\"h-what-the-operative-note-has-to-say\" class=\"wp-block-heading\">What the operative note has to say<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Documentation is the first line of defense in an audit. The operative note for 21925 has to capture specific elements that justify the code billed. A note that records only soft tissue biopsy performed will not support the deep variant. Practices using <a href=\"https:\/\/pabau.com\/features\/patient-intake-software\/\" rel=\"noopener\">digital procedure documentation<\/a> can build the required fields into their note templates, so nothing is missing at submission.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-21925\/digital-forms.webp\" alt=\"Pabau medical form builder showing a template library and a form preview\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&#8217;s medical form builder lets you add required fields for site and depth, so a 21925 note never leaves the room incomplete.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Maintaining <a href=\"https:\/\/pabau.com\/blog\/hipaa-compliance-for-medical-offices\/\" rel=\"noopener\">HIPAA-compliant documentation<\/a> means procedure notes stay secure and stay retrievable when an audit request lands. Filing a completed <a href=\"https:\/\/pabau.com\/templates\/who-surgical-safety-checklist\/\" rel=\"noopener\">surgical safety checklist<\/a> with the operative note gives a reviewer the whole encounter in one place.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Anatomical site specificity:<\/strong> The note must say back or flank, not trunk or posterior torso. Vague anatomical wording is a denial trigger.<\/li>\n\n\n\n<li><strong>Depth confirmation:<\/strong> The note must state that dissection extended below the subcutaneous layer into fascia, muscle, or a deep mass. This is the single most important element for choosing 21925 over 21920.<\/li>\n\n\n\n<li><strong>Biopsy versus excision:<\/strong> Say plainly that a specimen was taken and the lesion was left in place. This wording is what keeps the claim in the biopsy range rather than the excision range.<\/li>\n\n\n\n<li><strong>Clinical indication:<\/strong> Record the imaging or examination finding that justified a deep biopsy, including lesion size, location, and radiological characteristics where imaging guided the plan.<\/li>\n\n\n\n<li><strong>Technique description:<\/strong> Record the incision approach, the instruments used, the layers traversed, and how the specimen was obtained.<\/li>\n\n\n\n<li><strong>Specimen handling:<\/strong> Document how the specimen was labeled, preserved, and submitted for analysis, then link the biopsy to the pathology report in the record.<\/li>\n\n\n\n<li><strong>Pathology linkage:<\/strong> File the pathology report in the same encounter record. Once results arrive, the diagnosis code billed should reflect the pathological finding rather than the pre-biopsy impression.<\/li>\n<\/ul>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Audit your last 20 CPT 21925 claims and check whether each operative note states tissue depth below the subcutaneous layer. If depth confirmation is missing from more than one note in five, add a mandatory depth field. Fix the template before the next payer audit cycle.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-related-cpt-codes-for-back-and-flank-procedures\" class=\"wp-block-heading\">Related CPT codes for back and flank procedures<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT 21925 sits in a family of codes covering biopsy, excision, and radical resection of soft tissue in the back and flank. Knowing the full range helps when the surgeon removes the lesion instead of sampling it. Use the <a href=\"https:\/\/www.aapc.com\/codes\/cpt-codes-range\/\" target=\"_blank\" rel=\"nofollow noopener\">AAPC Codify CPT lookup<\/a> to cross-check descriptor language before you choose.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">CPT code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to use<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21920<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Biopsy, soft tissue of back or flank; superficial<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Biopsy limited to the subcutaneous layer; sampling does not pass below the fatty layer<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21925<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Biopsy, soft tissue of back or flank; deep<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Biopsy passing below the subcutaneous layer into fascia, muscle, or a deep mass<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21930<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Excision, tumor, soft tissue of back or flank area, subcutaneous; less than 3 cm<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Whole tumor removed from the subcutaneous layer, measuring under 3 cm<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21931<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Excision, tumor, soft tissue of back or flank area, subcutaneous; 3 cm or greater<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Same subcutaneous excision at 3 cm or greater<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21932<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Excision, tumor, soft tissue of back or flank area, subfascial (e.g., intramuscular); less than 5 cm<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Tumor removed from below the fascia, often intramuscular, measuring under 5 cm<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21933<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Excision, tumor, soft tissue of back or flank area, subfascial (e.g., intramuscular); 5 cm or greater<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Same subfascial excision at 5 cm or greater<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21935<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Radical resection of tumor (e.g., sarcoma), soft tissue of back or flank; less than 5 cm<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Wide resection of a malignant tumor with surrounding tissue, measuring under 5 cm<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21936<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Radical resection of tumor (e.g., sarcoma), soft tissue of back or flank; 5 cm or greater<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Wide resection of a malignant tumor at 5 cm or greater; the highest RVU in this range<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">20206<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Biopsy, muscle, percutaneous needle<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Needle sampling of muscle; less invasive than 21925, with a different approach and a lower RVU<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The line between 21925 and the excision codes is straightforward. Biopsy codes apply when a sample is taken and the mass stays in situ. Excision codes apply when the lesion comes out.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The size thresholds matter too. Subcutaneous excision splits at 3 cm, while subfascial excision and radical resection both split at 5 cm. Neighboring regions follow the same pattern, and <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21552\/\" rel=\"noopener\">CPT 21552<\/a> covers subcutaneous excision at 3 cm or greater in the neck and anterior thorax.<\/p>\n\n\n\n<h2 id=\"h-common-coding-errors-and-how-to-catch-them\" class=\"wp-block-heading\">Common coding errors and how to catch them<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Most 21925 denials trace back to five errors, and each one leaves a signature you can search for in your own claim data. Run these checks quarterly rather than waiting for a payer to find them.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>An excision code reported after a biopsy.<\/strong> Look for claims carrying 21930 through 21936 where the pathology report describes a biopsy specimen. Reconcile the code against the pathology wording before submission.<\/li>\n\n\n\n<li><strong>Depth missing from the note.<\/strong> Search your operative notes for fascia, muscle, and subcutaneous on every 21925 claim. Notes with none of those words are the ones a payer downcodes to 21920.<\/li>\n\n\n\n<li><strong>21925 treated as a minor procedure.<\/strong> Look for modifier 25 on E\/M visits linked to a 21925 date, and for separate visits inside 90 days. Both point to the wrong global period assumption.<\/li>\n\n\n\n<li><strong>An open code used for needle sampling.<\/strong> Flag any 21925 note that mentions core needle or percutaneous technique. Those cases belong to CPT 20206 and will not survive review.<\/li>\n\n\n\n<li><strong>The wrong rate for the place of service.<\/strong> Pull 21925 lines billed with POS 22 or POS 24 and check them against the facility rate. Anything paid near $543 from a facility setting needs correcting.<\/li>\n<\/ul>\n\n\n\n<h2 id=\"h-how-practice-management-software-keeps-cpt-21925-claims-clean\" class=\"wp-block-heading\">How practice management software keeps CPT 21925 claims clean<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT 21925 has several moving parts. Depth wording, the 090 global window, modifier choice, and ICD-10 pairing all have to agree before the claim goes out. Tracking that by hand stops working once a practice bills more than a handful of surgical codes a week.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practice management software like Pabau keeps the procedure note and the claim in the same system. Pabau&#8217;s <a href=\"https:\/\/pabau.com\/features\/claims-management-software\/\" rel=\"noopener\">claims management software<\/a> flags modifier requirements, checks code combinations against NCCI edits, and tracks denial patterns by CPT code. When depth is captured as a structured field in the note, it reaches the claim without a second data entry step.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The postoperative window is where a connected system pays for itself. With the biopsy date on the chart, a follow-up visit inside the 90 days is visible before anyone bills it separately. Running <a href=\"https:\/\/pabau.com\/blog\/practice-management-software\/\" rel=\"noopener\">practice management software<\/a> that holds billing and clinical notes together also keeps the link between the operative record and the claim auditable.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-21925\/automate-claims-through-healthcode.webp\" alt=\"Pabau checkout screen alongside a completed insurer invoice\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&#8217;s checkout builds the insurer invoice as the visit closes, so the code billed matches the procedure the surgeon recorded.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Knowing the descriptor is the easy part of this code. Getting paid depends on documentation capture, code validation, and modifier logic working together on the same record. Practices running notes and billing in separate systems tend to discover the mismatch at the audit instead.<\/p>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Keep surgical claims clean from note to payment                <\/h3>\n\n                <p class=\"description\">\n                    Pabau&#8217;s claims management tools help practices validate CPT codes, apply the right modifiers, and track denials on surgical codes like 21925. See how it fits your billing workflow.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau claims management dashboard for surgical billing\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 id=\"h-conclusion\" class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Two things decide whether a 21925 claim survives. The operative note has to say that dissection went below the subcutaneous layer. The 090 global period then governs the next 90 days of care, including which modifier belongs on any visit inside that window.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">So the fix sits upstream of billing, not in the claim scrubber. Put a required depth field in the operative note template, and keep the biopsy date somewhere the front desk can see it. Do both and the downcode to 21920 stops happening by accident.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pabau connects structured procedure documentation to claim submission, which removes the manual steps where errors collect. <a href=\"https:\/\/pabau.com\/book-demo\/\">Book a demo<\/a> to see how it handles surgical coding and postoperative windows in your practice.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Comparing claims tools before you switch billing systems?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/claims-management-software-pabau-vs-waystar\/\">Pabau vs Waystar<\/a> sets the two platforms side by side on submission, denial tracking, and reporting.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Coding dermatologic destruction procedures too?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-17107\/\">CPT 17107<\/a> walks through destruction of cutaneous vascular lesions, from descriptor to reimbursement.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Billing maxillofacial work from the same code chapter?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21497\/\">CPT 21497<\/a> covers interdental wiring, the modifiers it takes, and how reimbursement is calculated.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Standardizing your preoperative records?<\/strong> <a href=\"https:\/\/pabau.com\/templates\/history-and-physical-form\/\">History and physical form<\/a> gives you a ready structure for recording patient history before a procedure.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Want tighter notes through a 90-day window?<\/strong> <a href=\"https:\/\/pabau.com\/templates\/clinical-progress-notes\/\">Clinical progress notes<\/a> is a template for recording care as it progresses, including postoperative follow-up.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-frequently-asked-questions\" class=\"wp-block-heading\">Frequently asked questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1786522376934\"><h3 class=\"schema-faq-question\">What does CPT code 21925 describe?<\/h3> <p class=\"schema-faq-answer\">CPT code 21925 describes a deep biopsy of soft tissue in the back or flank. The surgeon incises below the subcutaneous layer, samples fascia, muscle, or a deep mass, and leaves the lesion in place. It is a biopsy code rather than an excision code. It sits in the Excision Procedures on the Back and Flank section, codes 21920 to 21936.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786522376935\"><h3 class=\"schema-faq-question\">What is the difference between CPT 21920 and CPT 21925?<\/h3> <p class=\"schema-faq-answer\">CPT 21920 covers a superficial biopsy limited to the subcutaneous layer, while CPT 21925 covers a deep biopsy reaching fascia, muscle, or a deep mass. The operative note must confirm that depth to support 21925. The two codes also differ in payment, at about $264 against about $543, and in global period, at 010 against 090.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786522376936\"><h3 class=\"schema-faq-question\">What is the Medicare reimbursement rate for CPT code 21925?<\/h3> <p class=\"schema-faq-answer\">The 2026 national Medicare payment for CPT 21925 is about $543 in a non-facility setting and about $373 in a facility setting. Those figures come from total RVUs of 16.26 and 11.16 multiplied by the 2026 conversion factor of $33.4009. Rates vary by locality and are reset with each annual fee schedule.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786522376937\"><h3 class=\"schema-faq-question\">What are the RVU values for CPT 21925?<\/h3> <p class=\"schema-faq-answer\">Under the 2026 fee schedule, CPT 21925 carries a work RVU of 4.51 and a malpractice RVU of 1.03. The practice expense RVU is 10.72 in a non-facility setting and 5.62 in a facility setting. That gives total RVUs of 16.26 non-facility and 11.16 facility. Confirm current values in the CMS relative value file before calculating payment.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786522376938\"><h3 class=\"schema-faq-question\">What is the global period for CPT code 21925?<\/h3> <p class=\"schema-faq-answer\">CPT 21925 carries a 090 global period, so Medicare treats it as major surgery. Payment covers the day before the procedure, the biopsy, and 90 days of routine postoperative care. Follow-up visits inside that window are not separately billable. An E\/M visit that leads to the biopsy takes modifier 57, not modifier 25.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786522376939\"><h3 class=\"schema-faq-question\">Can CPT 21925 be billed in an ambulatory surgery center?<\/h3> <p class=\"schema-faq-answer\">Yes. In an ambulatory surgery center, place of service 24, the surgeon bills 21925 at the facility rate of about $373. The ASC bills its own facility fee separately. Modifier 26 does not apply, because this code has no professional and technical component split. Billing the non-facility rate from an ASC is a compliance error.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786522376940\"><h3 class=\"schema-faq-question\">Can you bill CPT 21925 and an excision code for the same lesion?<\/h3> <p class=\"schema-faq-answer\">Not for the same lesion in the same session. When the surgeon samples a mass and then removes it in one operation, the biopsy bundles into the excision. Report only the excision code. If the excision happens later as a planned next step after pathology, report it with modifier 58 inside the 90-day global window.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786522376941\"><h3 class=\"schema-faq-question\">What are the NCCI edits for CPT 21925?<\/h3> <p class=\"schema-faq-answer\">NCCI edits define which codes cannot be billed alongside CPT 21925 without a valid modifier. The edit tables are reissued quarterly, so check the current quarter on the CMS site rather than relying on a static list. The CMS NCCI Policy Manual is the authoritative reference for the current rules.<\/p> <\/div> <\/div>\n\n","protected":false},"excerpt":{"rendered":"<p>CPT code 21925 is a deep soft tissue biopsy of the back or flank. 2026 RVUs, Medicare rates, and its 090 global period.<\/p>\n","protected":false},"author":82,"featured_media":176249,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"80","_yoast_wpseo_content_score":"30","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1546],"tags":[4116,1659,2776,1602,3583,1236,3357,2777],"class_list":["post-176250","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-cpt-codes","tag-billing-codes","tag-cms-rvu-assignment","tag-cpt-coding","tag-cpt-modifiers","tag-general-surgery-coding","tag-medicare-reimbursement","tag-muscle-biopsy-billing","tag-orthopedic-surgery"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.2 (Yoast SEO v28.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ 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is an all-in-one healthcare practice management software platform designed for clinics, medspas, therapists, and medical professionals. It combines scheduling, electronic health records, clinical forms, payments, marketing automation, reporting, and patient engagement tools into one secure cloud system to help practices streamline operations and grow their business.\",\"foundingDate\":\"2011-10-20\",\"numberOfEmployees\":{\"@type\":\"QuantitativeValue\",\"minValue\":\"201\",\"maxValue\":\"500\"}},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/#\\\/schema\\\/person\\\/b00aec1dd379f0ddcf6137d78e2a21db\",\"name\":\"Maja Popovska\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"es\",\"@id\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/06\\\/cropped-Maja-Popovska_WP-1-96x96.jpeg\",\"url\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/06\\\/cropped-Maja-Popovska_WP-1-96x96.jpeg\",\"contentUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/06\\\/cropped-Maja-Popovska_WP-1-96x96.jpeg\",\"caption\":\"Maja Popovska\"},\"description\":\"Maja is a Senior Content Writer at Pabau, where she covers everything from practice management and compliance to medical aesthetics and patient experience. Off the clock: binging true crime docuseries, baking and dreaming about travel.\",\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/blog\\\/author\\\/maja-popovska\\\/\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21925\\\/#faq-question-1786522376934\",\"position\":1,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21925\\\/#faq-question-1786522376934\",\"name\":\"What does CPT code 21925 describe?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"CPT code 21925 describes a deep biopsy of soft tissue in the back or flank. The surgeon incises below the subcutaneous layer, samples fascia, muscle, or a deep mass, and leaves the lesion in place. It is a biopsy code rather than an excision code. It sits in the Excision Procedures on the Back and Flank section, codes 21920 to 21936.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21925\\\/#faq-question-1786522376935\",\"position\":2,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21925\\\/#faq-question-1786522376935\",\"name\":\"What is the difference between CPT 21920 and CPT 21925?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"CPT 21920 covers a superficial biopsy limited to the subcutaneous layer, while CPT 21925 covers a deep biopsy reaching fascia, muscle, or a deep mass. The operative note must confirm that depth to support 21925. The two codes also differ in payment, at about $264 against about $543, and in global period, at 010 against 090.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21925\\\/#faq-question-1786522376936\",\"position\":3,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21925\\\/#faq-question-1786522376936\",\"name\":\"What is the Medicare reimbursement rate for CPT code 21925?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"The 2026 national Medicare payment for CPT 21925 is about $543 in a non-facility setting and about $373 in a facility setting. Those figures come from total RVUs of 16.26 and 11.16 multiplied by the 2026 conversion factor of $33.4009. Rates vary by locality and are reset with each annual fee schedule.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21925\\\/#faq-question-1786522376937\",\"position\":4,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21925\\\/#faq-question-1786522376937\",\"name\":\"What are the RVU values for CPT 21925?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Under the 2026 fee schedule, CPT 21925 carries a work RVU of 4.51 and a malpractice RVU of 1.03. The practice expense RVU is 10.72 in a non-facility setting and 5.62 in a facility setting. That gives total RVUs of 16.26 non-facility and 11.16 facility. Confirm current values in the CMS relative value file before calculating payment.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21925\\\/#faq-question-1786522376938\",\"position\":5,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21925\\\/#faq-question-1786522376938\",\"name\":\"What is the global period for CPT code 21925?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"CPT 21925 carries a 090 global period, so Medicare treats it as major surgery. Payment covers the day before the procedure, the biopsy, and 90 days of routine postoperative care. Follow-up visits inside that window are not separately billable. An E\\\/M visit that leads to the biopsy takes modifier 57, not modifier 25.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21925\\\/#faq-question-1786522376939\",\"position\":6,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21925\\\/#faq-question-1786522376939\",\"name\":\"Can CPT 21925 be billed in an ambulatory surgery center?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Yes. In an ambulatory surgery center, place of service 24, the surgeon bills 21925 at the facility rate of about $373. The ASC bills its own facility fee separately. Modifier 26 does not apply, because this code has no professional and technical component split. Billing the non-facility rate from an ASC is a compliance error.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21925\\\/#faq-question-1786522376940\",\"position\":7,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21925\\\/#faq-question-1786522376940\",\"name\":\"Can you bill CPT 21925 and an excision code for the same lesion?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Not for the same lesion in the same session. When the surgeon samples a mass and then removes it in one operation, the biopsy bundles into the excision. Report only the excision code. If the excision happens later as a planned next step after pathology, report it with modifier 58 inside the 90-day global window.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21925\\\/#faq-question-1786522376941\",\"position\":8,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21925\\\/#faq-question-1786522376941\",\"name\":\"What are the NCCI edits for CPT 21925?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"NCCI edits define which codes cannot be billed alongside CPT 21925 without a valid modifier. The edit tables are reissued quarterly, so check the current quarter on the CMS site rather than relying on a static list. The CMS NCCI Policy Manual is the authoritative reference for the current rules.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"}]}<\/script>\n<!-- \/ Yoast SEO Premium plugin. -->","yoast_head_json":{"title":"CPT code 21925: Deep soft tissue biopsy and 2026 RVUs","description":"CPT code 21925 is a deep soft tissue biopsy of the back or flank. 2026 RVUs, Medicare rates, and its 090 global period.","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21925\/","og_locale":"es_ES","og_type":"article","og_title":"CPT code 21925: Deep soft tissue biopsy and 2026 RVUs","og_description":"CPT code 21925 is a deep soft tissue biopsy of the back or flank. 2026 RVUs, Medicare rates, and its 090 global 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RVUs","isPartOf":{"@id":"https:\/\/pabau.com\/es\/#website"},"primaryImageOfPage":{"@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21925\/#primaryimage"},"image":{"@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21925\/#primaryimage"},"thumbnailUrl":"https:\/\/pabau.com\/wp-content\/uploads\/2026\/08\/cpt-code-21925.webp","datePublished":"2026-08-12T11:22:42+00:00","dateModified":"2026-08-12T14:21:38+00:00","description":"CPT code 21925 is a deep soft tissue biopsy of the back or flank. 2026 RVUs, Medicare rates, and its 090 global 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is an all-in-one healthcare practice management software platform designed for clinics, medspas, therapists, and medical professionals. It combines scheduling, electronic health records, clinical forms, payments, marketing automation, reporting, and patient engagement tools into one secure cloud system to help practices streamline operations and grow their business.","foundingDate":"2011-10-20","numberOfEmployees":{"@type":"QuantitativeValue","minValue":"201","maxValue":"500"}},{"@type":"Person","@id":"https:\/\/pabau.com\/es\/#\/schema\/person\/b00aec1dd379f0ddcf6137d78e2a21db","name":"Maja Popovska","image":{"@type":"ImageObject","inLanguage":"es","@id":"https:\/\/pabau.com\/wp-content\/uploads\/2026\/06\/cropped-Maja-Popovska_WP-1-96x96.jpeg","url":"https:\/\/pabau.com\/wp-content\/uploads\/2026\/06\/cropped-Maja-Popovska_WP-1-96x96.jpeg","contentUrl":"https:\/\/pabau.com\/wp-content\/uploads\/2026\/06\/cropped-Maja-Popovska_WP-1-96x96.jpeg","caption":"Maja Popovska"},"description":"Maja is a Senior Content Writer at Pabau, where she covers everything from practice management and compliance to medical aesthetics and patient experience. Off the clock: binging true crime docuseries, baking and dreaming about travel.","url":"https:\/\/pabau.com\/es\/blog\/author\/maja-popovska\/"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21925\/#faq-question-1786522376934","position":1,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21925\/#faq-question-1786522376934","name":"What does CPT code 21925 describe?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT code 21925 describes a deep biopsy of soft tissue in the back or flank. The surgeon incises below the subcutaneous layer, samples fascia, muscle, or a deep mass, and leaves the lesion in place. It is a biopsy code rather than an excision code. It sits in the Excision Procedures on the Back and Flank section, codes 21920 to 21936.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21925\/#faq-question-1786522376935","position":2,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21925\/#faq-question-1786522376935","name":"What is the difference between CPT 21920 and CPT 21925?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT 21920 covers a superficial biopsy limited to the subcutaneous layer, while CPT 21925 covers a deep biopsy reaching fascia, muscle, or a deep mass. The operative note must confirm that depth to support 21925. The two codes also differ in payment, at about $264 against about $543, and in global period, at 010 against 090.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21925\/#faq-question-1786522376936","position":3,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21925\/#faq-question-1786522376936","name":"What is the Medicare reimbursement rate for CPT code 21925?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"The 2026 national Medicare payment for CPT 21925 is about $543 in a non-facility setting and about $373 in a facility setting. Those figures come from total RVUs of 16.26 and 11.16 multiplied by the 2026 conversion factor of $33.4009. Rates vary by locality and are reset with each annual fee schedule.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21925\/#faq-question-1786522376937","position":4,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21925\/#faq-question-1786522376937","name":"What are the RVU values for CPT 21925?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Under the 2026 fee schedule, CPT 21925 carries a work RVU of 4.51 and a malpractice RVU of 1.03. The practice expense RVU is 10.72 in a non-facility setting and 5.62 in a facility setting. That gives total RVUs of 16.26 non-facility and 11.16 facility. Confirm current values in the CMS relative value file before calculating payment.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21925\/#faq-question-1786522376938","position":5,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21925\/#faq-question-1786522376938","name":"What is the global period for CPT code 21925?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT 21925 carries a 090 global period, so Medicare treats it as major surgery. Payment covers the day before the procedure, the biopsy, and 90 days of routine postoperative care. Follow-up visits inside that window are not separately billable. An E\/M visit that leads to the biopsy takes modifier 57, not modifier 25.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21925\/#faq-question-1786522376939","position":6,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21925\/#faq-question-1786522376939","name":"Can CPT 21925 be billed in an ambulatory surgery center?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Yes. In an ambulatory surgery center, place of service 24, the surgeon bills 21925 at the facility rate of about $373. The ASC bills its own facility fee separately. Modifier 26 does not apply, because this code has no professional and technical component split. Billing the non-facility rate from an ASC is a compliance error.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21925\/#faq-question-1786522376940","position":7,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21925\/#faq-question-1786522376940","name":"Can you bill CPT 21925 and an excision code for the same lesion?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Not for the same lesion in the same session. When the surgeon samples a mass and then removes it in one operation, the biopsy bundles into the excision. Report only the excision code. If the excision happens later as a planned next step after pathology, report it with modifier 58 inside the 90-day global window.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21925\/#faq-question-1786522376941","position":8,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21925\/#faq-question-1786522376941","name":"What are the NCCI edits for CPT 21925?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"NCCI edits define which codes cannot be billed alongside CPT 21925 without a valid modifier. The edit tables are reissued quarterly, so check the current quarter on the CMS site rather than relying on a static list. The CMS NCCI Policy Manual is the authoritative reference for the current rules.","inLanguage":"es"},"inLanguage":"es"}]}},"yoast":{"focus_keyword":"CPT code 21925","seo_title":"CPT code 21925: Deep soft tissue biopsy and 2026 RVUs","meta_description":"CPT code 21925 is a deep soft tissue biopsy of the back or flank. 2026 RVUs, Medicare rates, and its 090 global period.","content_score":"30","is_cornerstone":"","related_keyphrases":[{"keyword":"soft tissue biopsy CPT","score":61},{"keyword":"RVU musculoskeletal biopsy","score":61},{"keyword":"Medicare reimbursement biopsy","score":61}]},"_links":{"self":[{"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/posts\/176250","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/users\/82"}],"replies":[{"embeddable":true,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/comments?post=176250"}],"version-history":[{"count":4,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/posts\/176250\/revisions"}],"predecessor-version":[{"id":177057,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/posts\/176250\/revisions\/177057"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/media\/176249"}],"wp:attachment":[{"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/media?parent=176250"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/categories?post=176250"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/tags?post=176250"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}