Billing code 21603: Chest wall tumor excisionMedicare rate & RVUs in Guam
Reports surgical removal of a chest wall tumor with lymphadenectomy, when the operative service includes both tumor excision and lymph node dissection.
CMS doesn’t publish an office rate for 21603 in Guam.
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 21603 covers
A thoracic surgeon removes a chest wall tumor and performs lymphadenectomy during the same operation. This is a major surgical service generally performed in a hospital operating room. The operative report should establish the chest wall tumor being excised and describe the lymph node dissection performed as part of the procedure; a tumor excision alone or node sampling alone does not establish this combined service.
Select this code when the documented operation includes both components, distinguishing it from the related chest wall tumor excision code without lymphadenectomy. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. 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% multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; 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.
21603 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $1,673.65 |
How the 21603 rate is calculated
Each of 21603’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 · 21603
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 24.54Practice expense 19.34Malpractice 6.18
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21603
21603 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21603
Chest wall tumor excision
| 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) | 0.10/0.71/0.19 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 21603
Chest wall 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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
21603 without 51 · national facility
$1,672.05
Chest wall tumor excision
21603-51 · Second procedure: 50%
$836.03
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%).
21603 compared with similar codes
Compare codes
21603 vs 21602 vs 21601 vs 21600: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21602Chest wall tumor excision
- The key distinction is lymphadenectomy: 21603 includes it with the chest wall tumor excision, while 21602 describes the related excision without it.
- 21601Chest wall excision
- 21601 is a related chest wall tumor excision code identified with rib removal. Choose 21603 when the documented service includes lymphadenectomy.
- 21600Rib excision
- 21600 describes partial rib removal. It is not the combined chest wall tumor excision and lymphadenectomy service reported with 21603.
21603 billing questions
How does this differ from 21602?
Use 21603 when the chest wall tumor excision includes lymphadenectomy. Code 21602 identifies the related excision without lymphadenectomy.
Does tumor removal alone support 21603?
No. The operative report should document both chest wall tumor excision and lymphadenectomy performed during the operation.
Can modifier 50 be reported?
No. Bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures in that session are subject to the standard multiple-procedure reduction.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeons are paid only with 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
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