No office rate
This code is for superficial soft tissue; 27324 is for deep soft-tissue biopsy. Use the operative description of tissue depth to distinguish them.
On this page
CMS RVU26D · Effective 2026-10-01
27323 Soft-tissue biopsy Medicare reimbursement rates in Delaware
Reports surgical sampling of superficial soft tissue in the thigh or knee area when a lesion requires tissue diagnosis rather than complete removal. Compare 27323 office and facility rates across CMS payment localities in Delaware.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 27323 in Delaware?
Delaware has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$271.99
1 of 1 localities have a supported rate.
Payment area: Delaware
One mapped payment locality.
Facility setting
$156.16
1 of 1 localities have a supported rate.
Payment area: Delaware
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Musculoskeletal surgery
About 27323: Superficial thigh soft-tissue biopsy
Reports surgical sampling of superficial soft tissue in the thigh or knee area when a lesion requires tissue diagnosis rather than complete removal.
A surgeon removes a sample of superficial soft tissue from the thigh or knee area so the tissue can be examined for a suspected tumor or other abnormality. Orthopedic surgeons and surgical oncologists commonly perform the procedure in an outpatient operating room or procedure setting. The code distinguishes a superficial biopsy from sampling deeper soft tissue and from biopsy of the knee joint lining.
Report this code when the operative record supports sampling superficial tissue, rather than complete excision of the lesion. Document the biopsy site, the tissue sampled, and the operative findings; the pathology service may be reported separately when performed by another provider. This minor procedure has a 10-day global period, which includes related postoperative visits during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are paid at 50%. For bilateral reporting, modifier 50 is paid at 150%. Medicare does not pay an assistant at surgery for this procedure; co-surgeons and team surgery are not permitted.
CMS billing rules for 27323
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU2.27 · 28%
- Practice expense (office) RVU5.66 · 69%
- Malpractice RVU0.30 · 4%
396
Medicare services in 2024 · #3745 by national volume
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.
27323 compared with similar codes
Office rates for Delaware, from the same CMS release.
$532.56
Use this biopsy code when tissue is sampled. Code 27327 describes excision of a superficial thigh or knee-area lesion under its applicable size criterion.
No office rate
This code reports superficial tissue sampling, while 27328 describes excision of a deep thigh or knee-area tumor under its applicable size criterion.
No office rate
This code samples superficial soft tissue around the thigh or knee; 27330 is for biopsy of the knee joint lining.
Compare 27323 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Delaware →
Office / nonfacility
$271.99
Facility
$156.16
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 27323 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
2,834
- Code
- 27323
- Physician work
- 2.27
- Practice expense
- 5.66
- Malpractice
- 0.30
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.27 | × 1.005 | 2.2813 |
| Practice expense | 5.66 | × 0.988 | 5.5921 |
| Malpractice | 0.30 | × 0.899 | 0.2697 |
| Total RVUs | 8.1431 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Delaware$271.99
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.27 | 1.005 |
| Practice expense | 5.66 | 0.988 |
| Malpractice | 0.3 | 0.899 |
(2.27 × 1.005 + 5.66 × 0.988 + 0.3 × 0.899) × $33.4009 = $271.99
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.27 | 1.005 |
| Practice expense | 2.15 | 0.988 |
| Malpractice | 0.3 | 0.899 |
(2.27 × 1.005 + 2.15 × 0.988 + 0.3 × 0.899) × $33.4009 = $156.16
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
27323 billing questions
How do I distinguish this code from 27324?
Use 27323 for sampling superficial soft tissue in the thigh or knee area. Use 27324 when the biopsy is of deep soft tissue; the operative documentation should support the depth.
When is an excision code more appropriate?
This code describes sampling tissue, not removing the entire lesion. When the surgeon excises a superficial lesion or a deep tumor, consider the applicable excision code, such as 27327 or 27328, based on the documented procedure and lesion.
Can pathology be billed separately?
The surgeon's biopsy service and a pathologist's examination of the specimen are distinct services when each is performed and otherwise reportable. The operative record should identify the submitted tissue and the pathology report should document the examination.
What supports reporting the superficial level?
Document the thigh or knee-area site, the tissue sampled, and operative details that establish the biopsy was superficial rather than deep. A diagnosis of a mass alone does not establish the depth.
How does the 10-day global period affect follow-up?
Related postoperative visits during the 10 days after the biopsy are included in the global period. If other procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the multiple-procedure reduction.
How is a bilateral biopsy reported?
For a bilateral procedure, report modifier 50; CMS pays the bilateral service at 150%. An assistant at surgery is not paid, and co-surgeons and team surgery are 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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
2,83127306,,Incision of thigh tendon,A,,4.62,4.64,NA,4.64,,0.47,9.73,9.73,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,83227307,,Incision of thigh tendons,A,,5.91,4.78,NA,4.78,,0.57,11.26,11.26,0,090,0.10,0.69,0.21,2,1,0,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,83327310,,Exploration of knee joint,A,,9.75,8.83,NA,8.83,,2.05,20.63,20.63,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,83427323,,Biopsy thigh soft tissues,A,,2.27,5.66,,2.15,,0.30,8.23,4.72,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,83527324,,Biopsy thigh soft tissues,A,,4.91,6.01,NA,6.01,,1.13,12.05,12.05,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,83627325,,Neurectomy hamstring,A,,7.02,7.68,NA,7.68,,1.48,16.18,16.18,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,83727326,,Neurectomy popliteal,A,,6.31,7.46,NA,7.46,,1.33,15.10,15.10,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503