CPT code 27619: Subfascial tumor excision

Key takeaways

CPT code 27619 covers excision of a subfascial soft tissue tumor of the leg or ankle measuring less than 5 cm.

By contrast, subfascial means the tumor sits below the deep fascia or inside muscle, which is what separates 27619 from the subcutaneous code 27618.

In addition, Medicare prices 27619 at 13.06 total RVUs, or $436.22 nationally in 2026, and pays the same amount in every setting.

The code also carries a 90-day global period, and Medicare will not pay an assistant at surgery for it.

Finally, practice management software like Pabau submits and tracks claims, and checks that required fields are present before they go out.

CPT code 27619 covers excision of a soft tissue tumor in the leg or ankle. It applies when the tumor lies subfascially and measures less than 5 cm. Specifically, subfascial means the surgeon worked below the deep fascia, often inside muscle. As a result, that one detail separates 27619 from the subcutaneous codes beside it.

Getting the plane wrong is expensive in both directions. For example, in a hospital or ASC, billing 27618 instead of 27619 gives up about $138 per case at 2026 national rates. Conversely, billing 27619 for a subcutaneous lesion invites a post-payment recoupment.

This guide covers the descriptor, the 2026 RVUs and payment, the modifiers, the ICD-10 pairs, and the documentation reviewers ask for. Notably, every figure below comes from the CMS 2026 physician fee schedule relative value file.

CPT code 27619: official descriptor and clinical overview

The official descriptor reads: Excision, tumor, soft tissue of leg or ankle area, subfascial (eg, intramuscular); less than 5 cm. In turn, the code sits in the musculoskeletal surgery section of the CPT code set, which the American Medical Association maintains.

It describes a simple or marginal excision. In practice, the surgeon removes the tumor with only the margin needed to take it out cleanly, not a wide cuff of healthy tissue. Overall, three parameters decide whether 27619 is the right code:

• Location: The leg or ankle area, which covers the tibia and fibula region down to and including the ankle.
• Depth: Subfascial, meaning below the deep fascia. Intramuscular tumors, for example, sit in this group.
• Size: Less than 5 cm in greatest dimension.

Instead, size is not the length of the skin incision. Indeed, the American College of Surgeons describes it as the greatest diameter of the tumor plus the margin required to excise it. Measure at the time of resection, because formalin fixation shrinks tissue and a pathology measurement can drop a case into a lower code.

27618 vs 27619: the tissue plane decides

The deep fascia is the dividing line. For instance, a tumor above it is subcutaneous and belongs to 27618 or 27632. By contrast, a tumor below it, or within muscle, is subfascial and belongs to 27619 or 27634.

The size thresholds move with the family as well. For one thing, subcutaneous codes split at 3 cm. Meanwhile, subfascial codes split at 5 cm. A 4 cm tumor is therefore 27632 when it sits above the fascia and 27619 when it sits below it.

One step further out sits the skin. In this case, a lesion confined to the dermis and subcutaneous fat is an integumentary excision. CPT code 11404 and its neighbors apply rather than the 276xx series. In short, depth, not diagnosis, moves a case between those two chapters of the code set.

CPT 27619 RVU values

CMS assigns relative value units to every CPT code each year. Accordingly, the table below carries the 2026 values for CPT 27619, with the 2025 values alongside so you can see the direction of travel.

CMS never built a separate non-facility practice expense value for this code. Instead, the relative value file marks the non-facility field with an NA indicator, which flags a procedure that is rarely or never performed outside a facility. The facility value therefore stands in both columns, so the total is 13.06 either way.

Two changes pushed the total down for 2026. First, CMS applied a 2.5 percent efficiency adjustment to the work RVUs of most non-time-based codes. Second, the practice expense value fell as well. Verify current figures with the CMS Physician Fee Schedule lookup tool, since locality adjustment through the GPCI moves them again.

CPT 27619 fee schedule and reimbursement rates

Medicare payment is the total RVU multiplied by the annual conversion factor. In turn, the CY2026 physician fee schedule sets two of them. Specifically, clinicians outside a qualifying alternative payment model are paid at $33.4009, and those inside one are paid at $33.5675.

Payment does not move with the place of service here, because the facility practice expense value carries into both fields. Indeed, that is unusual in this family. By contrast, its subcutaneous neighbor 27618 pays $518.38 in the office and $298.27 in a facility, a spread of more than $200.

Compare 2026 with the year before. The conversion factor rose 3.3 percent, but 27619 lost RVUs, so national payment fell from $460.94 to $436.22. In other words, that is a 5.4 percent cut on a code whose headline conversion factor went up.

Commercial contracts are usually priced as a percentage of the Medicare schedule, so your allowable may sit well above $436.22. In fact, the published values behind every figure here live in the CMS relative value files.

Global period and payment rules for CPT 27619

CPT 27619 carries a 90-day global period. Specifically, the fee schedule splits that package into 10 percent preoperative work, 69 percent intraoperative work, and 21 percent postoperative care. Those percentages matter when care is shared, since the operating surgeon bills modifier 54 and the clinician handling follow-up bills modifier 55.

In addition, the same file carries five payment indicators that decide what else can be billed. They are published for every code, and they settle arguments that otherwise run on guesswork.

In practice, the assistant indicator has a scheduling consequence. A second surgeon can scrub in, but Medicare will not pay modifier 80, 81, or 82 on 27619. Submitting one produces a denial rather than a reduced payment. Build that into your surgical scheduling assumptions before the case, not after the remittance arrives.

Modifiers for CPT 27619

Modifier errors are a common source of denials and post-payment findings on surgical excision codes. Specifically, the table maps each modifier to the clinical situation that justifies it, which is what a reviewer looks for in the note.

Check modifier choices against the current AAPC CPT reference and the National Correct Coding Initiative edits before you bill. The NCCI tables are republished quarterly, so a pair that needed -59 last quarter may not need it now.

ICD-10 codes that pair with 27619

Every surgical claim needs a diagnosis code that establishes medical necessity. Indeed, the diagnosis has to support the reason for removing the tumor, not simply name the body part. Overall, these are the codes that pair with CPT 27619 most often.

D21.2 and C49.2 are category headers rather than billable codes, and a claim carrying either will reject. In addition, both require the fifth character that names the side. That laterality also has to agree with the -RT or -LT modifier on the procedure line. Consequently, a mismatch is one of the easiest audit flags to trip.

Update the diagnosis once pathology reports. If a mass coded to M79.89 comes back as a benign neoplasm, the corrected claim should carry D21.21 or D21.22 instead.

Documentation requirements for CPT code 27619

Documentation is what a payer reviews when a 27619 claim is questioned. Specifically, four records carry that review.

• Operative report: State the side, the plane in explicit terms, and the measured size of the tumor plus its margin. In fact, vague depth wording is the single most common reason a 27619 claim is downcoded.
• Pathology report: This, in turn, confirms the tissue type and supports the diagnosis code. Note that the pathology measurement may be smaller than the surgical one after fixation.
• Preoperative imaging: MRI or ultrasound usually establishes the depth before the case, which corroborates the subfascial claim independently of the note.
• Medical necessity notes: In addition, record symptoms, duration, any conservative treatment tried, and the clinical reason for removal. However, patient preference alone does not establish necessity for Medicare.

In practice, structured templates keep those elements from going missing. For instance, digital clinical documentation can force a plane, size, and laterality field on every operative note. Retaining those records under HIPAA-compliant documentation practices means they are available if a payer asks for them a year later.

Adjacent and related CPT codes

Picking the right code means matching three things: the site, the plane, and the size. Overall, the table sets out the leg and ankle family in full, with 2026 work RVUs so you can see how far apart the choices sit.

A radical resection is a different operation. Specifically, it removes the tumor together with a wide margin of surrounding normal tissue, and it is reported for malignant or aggressive tumors. Reaching for 27615 because the tumor felt difficult is an upcoding pattern reviewers look for. In fact, the work RVU difference makes it worth their time.

The same plane and size logic runs through the rest of the musculoskeletal chapter. For example, CPT code 21936 and CPT code 21920 repeat the pattern in the back and flank.

Likewise, CPT code 25110 applies the same thinking to tendon sheath lesions in the wrist. Staying in the leg and ankle, CPT code 27606 covers a tendon procedure rather than a soft tissue excision.

Some operations match no descriptor in the family at all. In this case, CPT code 20999 is the unlisted musculoskeletal option, and it needs a supporting report and a manually priced claim.

How practice management software supports CPT 27619 billing

Three things decide whether a 27619 claim pays first time. First, the operative note has to record the plane and the measured size. Second, the diagnosis has to carry laterality. Third, the claim itself has to leave with every required field populated.

For example, practice management software like Pabau keeps those pieces in one record. Surgeons write the operative note in the system, and the billing team works from that file rather than a printout that arrives days later.

In turn, Pabau’s claims management software submits claims electronically and tracks each one through to remittance. Before a claim goes out, it checks that the required fields are present, such as membership and authorization numbers. Notably, missing fields are a common cause of front-end rejection, and they are the cheapest kind of denial to prevent.

Code and modifier selection stays with your coder, where the clinical judgment belongs. Instead, what the software removes is the chasing. Automated workflows take the repetitive follow-up steps off your team, so tasks run on a schedule instead of living in someone’s memory.

Similarly, the same system serves physical therapy and sports medicine practices, holding scheduling, clinical notes, and billing together. That removes the re-keying that happens when data crosses between disconnected tools.

If you are rebuilding the wider process, our guide to healthcare revenue cycle management covers the steps either side of submission.

Keep surgical claims moving without the chase

Pabau submits and tracks claims from the same record that holds your operative notes, and checks required fields before each claim goes out. Your billing team spends less time re-keying and more time on the claims that need a person.

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Conclusion

CPT 27619 is a subfascial excision code, and the tissue plane is what earns it. For instance, a tumor above the deep fascia belongs to 27618 or 27632 whatever its size. By contrast, a tumor below the fascia and under 5 cm belongs here, at 13.06 RVUs and $436.22 nationally in 2026.

In short, the rest follows from the record. Write down the plane, the measured specimen, and the side, then pair it with a laterality-specific diagnosis code. To see how Pabau keeps operative notes and claims in one system, book a demo.

Continue your research

Coding a wide resection instead of a simple excision? CPT code 21936 covers the radical resection family in the back and flank, where the same size rules apply.

Working out whether the lesion was skin or soft tissue? CPT code 11404 covers benign lesion excision of the trunk, arms, and legs, the integumentary alternative to this family.

Need records that hold up in a payer audit? HIPAA-compliant documentation practices sets out how to structure and retain surgical records.

Billing a tendon procedure in the same region? CPT code 27606 covers percutaneous Achilles tenotomy in the leg and ankle.

Coding an operation the CPT book does not describe? CPT code 20999 sets out how unlisted musculoskeletal claims are documented and priced.

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