CPT code 21557: Tumor resection, radical, under 5 cm2026 Medicare rate & RVUs in Texas
Reports radical removal of a 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 21557 in Texas.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
Your location
On this page 9 sections
What 21557 covers
This code describes radical resection of a soft-tissue tumor in the neck or anterior thorax, such as a small soft-tissue sarcoma. The surgeon removes the tumor more extensively than with a limited excision, typically taking it out en bloc with a planned margin of surrounding tissue. These operations are generally performed in a hospital operating room by a surgeon experienced in head and neck or soft-tissue tumor surgery.
Select this code when the operative report supports radical resection and documents a tumor size under 5 cm; a limited deep excision or a biopsy is a different service. Record the site, measured size, depth, extent of removal, and operative technique. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued is paid in full and other procedures are subject to the standard 50% reduction. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is 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 21557 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | Unavailable | $888.81 |
| Beaumont, TX | Unavailable | $848.24 |
| Brazoria, TX | Unavailable | $860.69 |
| Dallas, TX | Unavailable | $870.78 |
| Fort Worth, TX | Unavailable | $869.16 |
| Galveston, TX | Unavailable | $866.28 |
| Houston, TX | Unavailable | $923.39 |
| Rest of Texas | Unavailable | $857.15 |
How the 21557 rate is calculated
Each of 21557’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 · 21557
RVUs × geographic indexes × conversion factor
Work14.38
14.38 RVUs× 1.000 GPCI
Practice expense8.92
8.92 RVUs× 1.000 GPCI
Malpractice3.12
3.12 RVUs× 1.000 GPCI
Adjusted RVUs
26.4200
Conversion factor
$33.4009
Medicare rate
$882.45
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21557
21557 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21557
Tumor resection, radical, 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) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| 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 · 21557
Tumor resection, radical, 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
21557 without 51 · national facility
$882.45
Tumor resection, radical, under 5 cm
21557-51 · Second procedure: 50%
$441.23
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%).
21557 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 21558Tumor resectionNeck/anterior thorax, 5 cm or larger
- Both describe radical tumor resection in the neck or anterior thorax; 21558 is for tumors 5 cm or greater, while 21557 is for tumors under 5 cm.
- 21556Tumor excisionDeep, under 5 cm
- Use 21556 for deep soft-tissue tumor excision under 5 cm when the documented procedure is an excision, not a radical resection.
- 21550Soft-tissue biopsyDeep neck or thorax
- 21550 reports biopsy for tissue diagnosis. Use 21557 when the surgeon performs radical removal of the tumor rather than sampling it.
21557 billing questions
How is this different from code 21556?
Code 21557 is for radical tumor resection, while 21556 describes a deep soft-tissue tumor excision. The operative report should support the more extensive radical approach, not just the tumor's depth and size.
Does the tumor size include surrounding tissue removed?
Use the tumor's documented size to determine whether it is under 5 cm. Document the tumor measurement separately from the extent of the specimen or margin removed.
What documentation supports reporting 21557?
Document the neck or anterior thorax site, tumor size, depth, and the radical nature and extent of the resection. The operative report should distinguish the service from a biopsy or limited excision.
How are other procedures in the same session paid?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50% when performed in the same session.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid for this procedure. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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
Fee sheets · Coming soon
Put 21557 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist