CPT code 21556: Tumor excision, deep, under 5 cm2026 Medicare rate & RVUs in Oregon
Report this service for excision of a subfascial soft-tissue tumor in the neck or anterior thorax when the tumor measures less than 5 cm.
CMS doesn’t publish an office rate for 21556 in Oregon.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 21556 covers
This code describes removal of a soft-tissue tumor beneath the superficial fascia, such as a lesion within muscle, in the neck or anterior thorax. It is used when the surgeon excises the tumor and its size is under 5 cm. Head and neck surgeons and general surgeons may perform the procedure in an operating room or another setting equipped for surgical excision. The code is for a deep tumor, not a subcutaneous lesion or a limited diagnostic sample.
Choose the code based on the tumor’s depth, location, size, and the work actually performed. Document the anatomic site, subfascial plane, tumor measurement, and extent of removal; distinguish excision from a more extensive resection. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care for 90 days. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery billing are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 21556 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland, OR | Unavailable | $504.02 |
| Rest of Oregon | Unavailable | $475.88 |
How the 21556 rate is calculated
Each of 21556’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 21556
RVUs × geographic indexes × conversion factor
Work7.47
7.47 RVUs× 1.000 GPCI
Practice expense5.76
5.76 RVUs× 1.000 GPCI
Malpractice1.48
1.48 RVUs× 1.000 GPCI
Adjusted RVUs
14.7100
Conversion factor
$33.4009
Medicare rate
$491.33
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21556
21556 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21556
Tumor excision, deep, under 5 cm
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.69/0.21 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 21556
Tumor excision, deep, under 5 cm
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
21556 without 51 · national facility
$491.33
Tumor excision, deep, under 5 cm
21556-51 · Second procedure: 50%
$245.67
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
21556 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 21554Tumor excisionDeep, 5 cm or larger
- This code applies to a deep soft-tissue tumor under 5 cm; 21554 is for a tumor 5 cm or larger.
- 21557Tumor resectionRadical, under 5 cm
- Both involve a deep soft-tissue tumor under 5 cm, but 21557 represents resection rather than excision.
- 21552Soft-tissue excisionSubcutaneous, 3 cm or larger
- 21552 is for a subcutaneous lesion 3 cm or larger. Use 21556 when the tumor is beneath the superficial fascia.
- 21550Soft-tissue biopsyDeep neck or thorax
- 21550 represents biopsy for diagnostic sampling. This code represents excision of a deep tumor under 5 cm.
21556 billing questions
How does this differ from 21554?
Both describe deep soft-tissue tumor excision in the neck or anterior thorax. Use 21556 for a tumor under 5 cm and 21554 for one 5 cm or larger.
When would 21552 or 21555 be more appropriate?
Those codes describe excision of a subcutaneous lesion. This code is for a tumor beneath the superficial fascia, such as one within muscle.
Can a diagnostic biopsy of the same tumor be reported with the excision?
When the tumor is excised during the same session, a separate biopsy of that same lesion generally is not separately reported as an additional procedure.
What documentation supports reporting 21556?
Record the neck or anterior thorax site, the tumor’s subfascial location, its size, and the extent of excision. The record should support that the tumor measures less than 5 cm.
Can modifier 50 or an assistant-at-surgery claim be used?
Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for this service.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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