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Billing code 49215: Tumor excisionMedicare rate & RVUs

Reports operative removal of a tumor in the presacral space or sacrum, such as a sacral chordoma, rather than an intra-abdominal mass.

CMS RVU26DEffective Oct 1, 2026109 payment localities131 Medicare services in 2024

Medicare pays $2,003.39 for 49215 nationally in a facility.

Medicare rate · 49215

Tumor excision

Swap in your local Medicare rate.

Work RVUs
36.86
Total RVUs
59.98
Global days
090

National rate · 2026

$2,003.39

Facility setting, before claim adjustments.

See every locality for 49215 → · Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

On this page 8 sections
  1. Medicare rate
  2. What 49215 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Billing questions
  8. Sources

What 49215 covers

This service covers operative removal of a tumor arising in the presacral space or sacrum. Examples include a sacral chordoma or a presacral mass requiring excision. Depending on the tumor’s location and extent, the operation may use an abdominal, posterior, or combined approach. Colorectal or general surgeons, surgical oncologists, orthopedic spine surgeons, and neurosurgeons may perform the procedure in a hospital operating room.

Select the code based on the presacral or sacral location, not a size tier used for other intra-abdominal tumor excisions. The operative report should identify the tumor’s site and describe its removal and surgical approach. This major surgery has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in one session, the highest-valued is paid in full and the others at 50%. Modifier 50 is inappropriate for this service. 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 49215 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

49215 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,823.46
Alaska*Unavailable$2,530.44
ArizonaUnavailable$1,948.95
ArkansasUnavailable$1,801.66
AtlantaUnavailable$2,069.36
AustinUnavailable$2,004.22
BakersfieldUnavailable$1,969.48
Baltimore/Surr. CntysUnavailable$2,123.72
BeaumontUnavailable$1,939.01
BrazoriaUnavailable$1,949.34

49215 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
49215 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 49215 rate is calculated

Each of 49215’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 · 49215

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 36.86Practice expense 15.04Malpractice 8.08

59.9800 adjusted RVUs×$33.4009 conversion factor=$2,003.39

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 49215

49215 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 49215

Tumor excision

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.09/0.81/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 49215

Tumor excision

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

49215 without 51 · national facility

$2,003.39

Tumor excision

49215-51 · Second procedure: 50%

$1,001.70

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%).

When to use modifier 51

49215 billing questions

How is this code distinguished from size-based intra-abdominal tumor excisions?

Use this code for a tumor in the presacral space or sacrum. The intra-abdominal tumor codes are selected for tumors at other covered sites, with size determining the level.

Does tumor size determine code selection?

No. The key distinction is the presacral or sacral location, not a size threshold.

Can modifier 50 be reported?

No. Modifier 50 is inappropriate for this service and anatomy.

What documentation supports reporting this code?

The operative report should identify the presacral or sacral tumor, its location, the surgical approach, and the excision performed.

How does the global period affect postoperative billing?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

Can an assistant or co-surgeon be reported?

An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.

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
RVUs for 49215PPRRVU2026_Oct_nonQPP.csv, line 5,780 (RVU26D)

Open CMS sourceHow we calculate rates

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