No office rate
Use 21936 when the radical back or flank tumor resection is for a tumor measuring 5 cm or greater; 21935 is for one under 5 cm.
On this page
CMS RVU26D · Effective 2026-10-01
21935 Tumor resection Medicare reimbursement rates in Idaho
Reports radical removal of a soft-tissue tumor in the back or flank measuring under 5 cm, typically when an oncologic operation requires wider tissue removal. Compare 21935 office and facility rates across CMS payment localities in Idaho.
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 21935 in Idaho?
Idaho 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
No supported rate
Facility setting
$866.52
1 of 1 localities have a supported rate.
Payment area: Idaho
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 21935: Radical back or flank tumor resection under 5 cm
Reports radical removal of a soft-tissue tumor in the back or flank measuring under 5 cm, typically when an oncologic operation requires wider tissue removal.
This code describes a radical operation to remove a soft-tissue tumor in the back or flank that measures less than 5 cm. Unlike a limited excision, the procedure involves a wider removal of tumor and surrounding soft tissue for oncologic treatment, such as management of a soft-tissue sarcoma. A surgeon performs it in an operative setting; the operative report should make the location, tumor size, and extent of resection clear.
Report the code when the documented operation is radical, not simply because a mass is deep or requires an incision. Distinguish it from biopsy and less extensive excision codes, and support the size threshold and resection extent in the record. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment is restricted; co-surgeons are paid only with supporting documentation, and team surgery is not permitted.
CMS billing rules for 21935
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care 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 adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU15.33 · 54%
- Practice expense (office) RVU9.68 · 34%
- Malpractice RVU3.61 · 13%
186
Medicare services in 2024 · #4379 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.
21935 compared with similar codes
Office rates for Idaho, from the same CMS release.
No office rate
Use 21932 for subfascial tumor excision without the radical oncologic extent represented by 21935.
$496.32
Use 21925 for deep diagnostic tissue sampling. Use 21935 when the documented service is radical removal of the tumor.
Compare 21935 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
Idaho →
Office / nonfacility
Unavailable
Facility
$866.52
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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 21935 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
2,039
- Code
- 21935
- Physician work
- 15.33
- Practice expense
- 9.68
- Malpractice
- 3.61
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 15.33 | × 1.000 | 15.3300 |
| Practice expense | 9.68 | × 0.920 | 8.9056 |
| Malpractice | 3.61 | × 0.473 | 1.7075 |
| Total RVUs | 25.9431 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Idaho$866.52
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 15.33 | 1 |
| Practice expense | 9.68 | 0.92 |
| Malpractice | 3.61 | 0.473 |
(15.33 × 1 + 9.68 × 0.92 + 3.61 × 0.473) × $33.4009 = $866.52
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.
21935 billing questions
How is this code different from a simple back or flank tumor excision?
This code is for a radical oncologic resection, not a routine removal based only on the mass's location or depth. The operative report should support the wider extent of tissue removal.
Does a tumor under 5 cm qualify based on size alone?
No. The documented operation must be radical, and the tumor must meet the under-5-cm size threshold. Size alone does not distinguish this service from a less extensive excision.
Can a biopsy be reported instead for the same mass?
A biopsy code describes diagnostic tissue sampling, rather than definitive radical removal. Choose based on the service actually performed and documented.
Is modifier 50 appropriate for tumors on both sides of the back?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does the 90-day global period affect postoperative visits?
The global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. 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 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.
2,03621931,,Exc back les sc 3 cm/>,A,,6.71,5.21,NA,5.21,,1.66,13.58,13.58,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,03721932,,Exc back tum deep < 5 cm,A,,9.57,6.96,NA,6.96,,2.25,18.78,18.78,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,03821933,,Exc back tum deep 5 cm/>,A,,10.85,7.47,NA,7.47,,2.64,20.96,20.96,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,03921935,,Resect back tum < 5 cm,A,,15.33,9.68,NA,9.68,,3.61,28.62,28.62,0,090,0.10,0.69,0.21,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,04021936,,Resect back tum 5 cm/>,A,,21.99,11.94,NA,11.94,,5.23,39.16,39.16,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,04122010,,I&d p-spine c/t/cerv-thor,A,,12.43,12.05,NA,12.05,,3.99,28.47,28.47,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,04222015,,I&d abscess p-spine l/s/ls,A,,12.32,11.66,NA,11.66,,3.62,27.60,27.60,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772