Billing code 27646: Bone tumor resectionMedicare rate & RVUs in Guam
Reports operative resection of a tumor involving the fibula, typically by an orthopedic surgeon when the treatment requires removal of the affected bone segment.
CMS doesn’t publish an office rate for 27646 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 27646 covers
This code represents operative resection of a tumor involving the fibula, rather than a limited sampling procedure. It is typically performed by an orthopedic surgeon, often an orthopedic oncologist, in a hospital operating room for a primary or metastatic bone tumor requiring removal of the involved portion of the fibula. The operative report should identify the fibular site and describe the resection performed.
Choose the code based on the operation documented, not tumor size alone: distinguish tumor resection from a more limited lesion removal or partial fibular excision. Document the diagnosis, laterality, extent of bone removed, and any reconstruction performed. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be available; 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.
27646 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $1,386.83 |
How the 27646 rate is calculated
Each of 27646’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 · 27646
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 22.63Practice expense 14.16Malpractice 4.82
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 27646
27646 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 27646
Bone 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| 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 · 27646
Bone 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 50 · payment effect
With and without the modifier
27646 without 50 · national facility
$1,389.81
Bone tumor resection
27646-50 · Bilateral: 150%
$2,084.72
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
27646 compared with similar codes
Compare codes
27646 vs 27641 vs 27635 vs 27645 vs 27637: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 27641Fibula excision
- 27641 describes partial removal of the fibula. Use 27646 when the documented operation is resection of a fibular tumor.
- 27635Bone lesion removal
- 27635 is for removal of a lower-leg bone lesion. Distinguish it from 27646 by the documented tumor-resection service and the fibular site.
- 27645Tibial tumor resection
- Both codes describe tumor resection, but 27645 is for the tibia and 27646 is for the fibula.
- 27637Bone lesion grafting
- 27637 describes lower-leg bone lesion removal with grafting. Choose 27646 when the documented service is fibular tumor resection.
27646 billing questions
How is this different from code 27641?
Code 27646 describes resection of a fibular tumor. Code 27641 describes partial removal of the fibula; select according to the documented procedure and its purpose.
How is this different from code 27635?
Code 27635 covers removal of a lower-leg bone lesion. Use 27646 when the operative service is a tumor resection involving the fibula, rather than a more limited lesion-removal procedure.
What documentation supports reporting 27646?
The operative report should identify the fibula as the tumor site and describe the extent of bone resected, laterality, and any reconstruction performed.
How are bilateral procedures reported?
For a bilateral procedure performed in the same session, report modifier 50; CMS pays the bilateral procedure at 150%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team surgery is not permitted under the CMS facts for this code.
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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