Billing code 21936: Back tumor resectionMedicare rate & RVUs in Delaware
Reports resection of a deep soft tissue tumor of the back or flank measuring at least 5 cm, such as a tumor beneath the fascia.
CMS doesn’t publish an office rate for 21936 in Delaware.
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 9 sections
What 21936 covers
This code describes operative resection of a large soft tissue tumor in the back or flank that lies beneath the fascia, including an intramuscular tumor. It is used for therapeutic removal, not for taking a diagnostic sample alone. Surgeons, including general and surgical oncology specialists, may perform the procedure in a hospital or other surgical setting. The operative report should establish the tumor’s deep location, size, and the resection performed.
Choose this code when the resected tumor is 5 cm or larger and the procedure meets the resection service represented by this code. Distinguish it from codes for smaller deep tumors, excision rather than resection, and superficial lesions; document the size and tissue plane. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is not appropriate for this service. An assistant at surgery may be paid; co-surgeons require 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.
21936 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | Unavailable | $1,289.22 |
How the 21936 rate is calculated
Each of 21936’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 · 21936
RVUs × geographic indexes × conversion factor
Work21.99
21.99 RVUs× 1.000 GPCI
Practice expense11.94
11.94 RVUs× 1.000 GPCI
Malpractice5.23
5.23 RVUs× 1.000 GPCI
Adjusted RVUs
39.1600
Conversion factor
$33.4009
Medicare rate
$1,307.98
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21936
21936 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21936
Back tumor resection
| 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 · 21936
Back tumor resection
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
21936 without 51 · national facility
$1,307.98
Back tumor resection
21936-51 · Second procedure: 50%
$653.99
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%).
21936 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 21935Tumor resection
- This code is for a deep back or flank tumor resection measuring 5 cm or larger; 21935 is the corresponding resection code for a tumor under 5 cm.
- 21933Back tumor excision
- Both concern a deep back or flank tumor at least 5 cm. Choose 21936 for a resection service and 21933 when the documented procedure is an excision.
- 21925Soft-tissue biopsy
- 21925 reports a diagnostic biopsy of deep back soft tissue. This code reports resection of a large deep tumor, not sampling alone.
- 21931Back mass excision
- 21931 concerns excision of a subcutaneous back or flank lesion measuring 3 cm or larger. This code is for a deep tumor at least 5 cm and a resection service.
21936 billing questions
How is this code distinguished from 21935?
Both describe resection of a deep back or flank tumor. Use 21936 for a tumor measuring 5 cm or larger and 21935 for one under 5 cm.
How does this differ from 21933?
21933 describes excision of a deep back or flank tumor measuring 5 cm or larger. Select between the codes based on the procedure actually performed and documented, not size alone.
Can a biopsy be reported with the resection?
A separate diagnostic biopsy is not represented by this resection code. Code 21925 describes biopsy of deep soft tissue of the back; report separate services only when independently performed and supported by the record.
What documentation supports code selection?
Document the tumor’s back or flank location, its relationship to the fascia or muscle, its size, and the resection performed. The record should support the distinction from a superficial or smaller tumor service.
Can modifier 50 be used for tumors on both sides?
No. Modifier 50 is not appropriate for this back or flank tumor resection.
How does the multiple-procedure reduction affect payment?
When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the other procedures are subject to the standard 50% reduction.
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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