$475.58
This code is for a small superficial soft-tissue lesion of the leg or ankle. Choose 27630 when the lesion arises from a tendon sheath or related capsule.
On this page
CMS RVU26D · Effective 2026-10-01
27630 Tendon lesion excision Medicare reimbursement rates in Idaho
Reports surgical removal of a lesion arising from a tendon sheath or related capsule in the leg or ankle, such as a localized cyst. Compare 27630 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 27630 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
$523.91
1 of 1 localities have a supported rate.
Payment area: Idaho
One mapped payment locality.
Facility setting
$321.09
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.
Orthopedic surgery
About 27630: Excision of tendon sheath lesion
Reports surgical removal of a lesion arising from a tendon sheath or related capsule in the leg or ankle, such as a localized cyst.
This operation removes a focal lesion arising from a tendon sheath or related capsule in the leg or ankle. A typical example is a localized cyst associated with a tendon sheath. Orthopedic surgeons commonly perform the procedure in a hospital outpatient department or ambulatory surgery center; it may also be performed in an office setting. The operative record should identify the lesion’s site and its relationship to the tendon sheath or capsule, rather than describing only a nearby soft-tissue mass.
Report the code when the surgeon excises the tendon-sheath or capsular lesion, not when the service is limited to diagnostic tissue sampling or removal of a separate soft-tissue mass. Documentation should describe the operative approach and removal. CMS assigns a 90-day major-surgery global period, including the day-before preoperative visit and 90 days of related postoperative care. For bilateral procedures with modifier 50, CMS pays at 150%. When multiple procedures occur in one session, the highest-valued procedure is paid in full and others at 50%. Assistant-at-surgery payment is restricted; co-surgeons and team surgery are not permitted.
CMS billing rules for 27630
- 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 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 RVU4.82 · 28%
- Practice expense (office) RVU11.44 · 67%
- Malpractice RVU0.72 · 4%
729
Medicare services in 2024 · #3228 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.
27630 compared with similar codes
Office rates for Idaho, from the same CMS release.
No office rate
This code addresses a deep soft-tissue lesion under 5 cm. Choose 27630 based on tendon-sheath or capsular origin, not the lesion’s depth alone.
No office rate
This code removes ankle-joint lining. It is distinct from excision of a focal lesion arising from a tendon sheath or related capsule.
Compare 27630 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
$523.91
Facility
$321.09
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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 27630 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
2,981
- Code
- 27630
- Physician work
- 4.82
- Practice expense
- 11.44
- Malpractice
- 0.72
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.82 | × 1.000 | 4.8200 |
| Practice expense | 11.44 | × 0.920 | 10.5248 |
| Malpractice | 0.72 | × 0.473 | 0.3406 |
| Total RVUs | 15.6854 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Idaho$523.91
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.82 | 1 |
| Practice expense | 11.44 | 0.92 |
| Malpractice | 0.72 | 0.473 |
(4.82 × 1 + 11.44 × 0.92 + 0.72 × 0.473) × $33.4009 = $523.91
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.82 | 1 |
| Practice expense | 4.84 | 0.92 |
| Malpractice | 0.72 | 0.473 |
(4.82 × 1 + 4.84 × 0.92 + 0.72 × 0.473) × $33.4009 = $321.09
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.
27630 billing questions
How is this different from excision of a leg or ankle soft-tissue mass?
Use this code when the lesion arises from a tendon sheath or related capsule. Codes for soft-tissue lesions are selected when the mass is in the surrounding tissue, using its depth and size.
What operative documentation supports this code?
Document the leg or ankle site, the lesion’s relationship to the tendon sheath or capsule, and that the lesion was excised. A description of a mass without its anatomic origin may not distinguish this service from soft-tissue excision.
Can a biopsy or exploration be reported separately?
The code represents excision of the tendon-sheath or capsular lesion, rather than a service limited to biopsy or exploration. The operative note should clarify whether the lesion was removed or only sampled.
How does CMS handle bilateral procedures and multiple procedures?
For a bilateral procedure reported with modifier 50, CMS pays at 150%. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%.
Are assistant surgeons or co-surgeons payable?
CMS applies a statutory restriction to assistant-at-surgery payment for this code. 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.
2,97827620,,Explore/treat ankle joint,A,,6.00,6.01,NA,6.01,,1.03,13.04,13.04,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,97927625,,Remove ankle joint lining,A,,8.28,6.79,NA,6.79,,1.34,16.41,16.41,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,98027626,,Remove ankle joint lining,A,,8.87,6.69,NA,6.69,,1.33,16.89,16.89,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,98127630,,Removal of tendon lesion,A,,4.82,11.44,,4.84,,0.72,16.98,10.38,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,98227632,,Exc leg/ankle les sc 3 cm/>,A,,5.76,4.79,NA,4.79,,1.22,11.77,11.77,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,98327634,,Exc leg/ankle tum dep 5 cm/>,A,,9.88,6.86,NA,6.86,,1.92,18.66,18.66,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,98427635,,Remove lower leg bone lesion,A,,7.83,7.12,NA,7.12,,1.39,16.34,16.34,0,090,0.10,0.69,0.21,2,1,1,1,0,9,,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