Billing code 21552: Soft-tissue excisionMedicare rate & RVUs in Illinois
Report this service for complete removal of a subcutaneous neck or anterior chest soft-tissue lesion measuring at least 3 cm.
CMS doesn’t publish an office rate for 21552 in Illinois.
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 21552 covers
An otolaryngologist, general surgeon, or plastic surgeon may remove a palpable lipoma, cyst, or other soft-tissue mass in the subcutaneous layer of the neck or anterior chest. The operation removes the lesion rather than taking only a diagnostic sample. It may occur in an office procedure room or operating room depending on the lesion and patient’s needs.
Choose 21552 when the lesion is subcutaneous and measures at least 3 cm; its depth and size distinguish it from codes for smaller superficial lesions or deeper tumors. Document the site, size, tissue plane, and excision performed. This major-surgery service includes 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 for this code’s descriptor and anatomy. An assistant at surgery may be paid; co-surgeons and team surgery are 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.
Where 21552 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | Unavailable | $496.40 |
| East St. Louis | Unavailable | $466.59 |
| Rest Of Illinois | Unavailable | $442.82 |
| Suburban Chicago | Unavailable | $473.89 |
How the 21552 rate is calculated
Each of 21552’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 · 21552
RVUs × geographic indexes × conversion factor
Work6.33
6.33 RVUs× 1.000 GPCI
Practice expense5.02
5.02 RVUs× 1.000 GPCI
Malpractice1.50
1.50 RVUs× 1.000 GPCI
Adjusted RVUs
12.8500
Conversion factor
$33.4009
Medicare rate
$429.20
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21552
21552 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21552
Soft-tissue 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) | 0 | Not permitted. |
| 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 · 21552
Soft-tissue 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
21552 without 51 · national facility
$429.20
Soft-tissue excision
21552-51 · Second procedure: 50%
$214.60
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%).
21552 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 21555Mass excision
- Both concern superficial neck or anterior chest lesions. The size threshold is the distinction: 21552 is for lesions at least 3 cm; 21555 is for lesions under 3 cm.
- 21554Tumor excision
- This code is for a deep neck tumor measuring 5 cm or larger. Choose 21552 for a subcutaneous lesion measuring at least 3 cm.
- 21556Tumor excision
- This code is for a deep neck tumor under 5 cm. Use 21552 when the lesion is subcutaneous and at least 3 cm.
- 21550Soft-tissue biopsy
- 21550 represents a soft-tissue biopsy for diagnosis; 21552 represents excision of the qualifying subcutaneous lesion.
21552 billing questions
How is 21552 distinguished from 21555?
Both describe removal of a subcutaneous neck or anterior chest lesion. Use 21552 for a lesion measuring 3 cm or larger and 21555 for one under 3 cm.
When should a deep-tumor code be considered instead?
Use the deep-tumor code family when the operative documentation places the mass beneath the subcutaneous tissue, such as in a deeper soft-tissue plane. Select within that family by its size threshold.
Does 21552 include postoperative visits?
Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can modifier 50 be used for bilateral lesions?
No. Modifier 50 is inappropriate for this code’s descriptor and anatomy.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures performed in that session are subject to the standard multiple-procedure 50% reduction.
May an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons and team surgery are not permitted 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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