No office rate
21550 samples deep neck or thorax soft tissue for diagnosis. 21552 removes a subcutaneous neck lesion measuring 3 cm or larger.
On this page
CMS RVU26D · Effective 2026-10-01
21550 Soft-tissue biopsy Medicare reimbursement rates in Indiana
Reports a deep soft-tissue biopsy in the neck or thorax when tissue is sampled to establish a diagnosis rather than remove the mass. Compare 21550 office and facility rates across CMS payment localities in Indiana.
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 21550 in Indiana?
Indiana 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
$252.64
1 of 1 localities have a supported rate.
Payment area: Indiana
One mapped payment locality.
Facility setting
$133.74
1 of 1 localities have a supported rate.
Payment area: Indiana
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.
Surgical biopsy
About 21550: Deep neck or thorax soft-tissue biopsy
Reports a deep soft-tissue biopsy in the neck or thorax when tissue is sampled to establish a diagnosis rather than remove the mass.
This code describes surgical sampling of deep soft tissue in the neck or thorax for diagnostic evaluation, such as obtaining tissue from a deep mass. A surgeon, otolaryngologist, or thoracic surgeon may perform the procedure in an office-based setting or hospital operating room, depending on the location and access required. The service is a biopsy, not removal of a neck lesion or tumor as definitive treatment.
Choose the code when the operative record supports a deep soft-tissue biopsy in the specified anatomic region. Document the site, depth, approach, and diagnostic purpose; codes for excising neck lesions or tumors are selected when the tissue is removed rather than sampled. The 10-day global period includes related postoperative visits during that period. When multiple procedures are performed 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 descriptor and anatomy. CMS does not pay an assistant at surgery for this code, and co-surgeon and team-surgery reporting are not permitted.
CMS billing rules for 21550
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days 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 not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU2.06 · 25%
- Practice expense (office) RVU5.78 · 71%
- Malpractice RVU0.30 · 4%
1.3K
Medicare services in 2024 · #2782 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.
21550 compared with similar codes
Office rates for Indiana, from the same CMS release.
$426.17
Choose 21550 for a deep soft-tissue biopsy; 21555 describes removal of a subcutaneous neck lesion smaller than 3 cm.
No office rate
21554 is for excision of a deep neck tumor measuring 5 cm or larger, not diagnostic sampling.
No office rate
21556 describes excision of a deep neck tumor smaller than 5 cm; 21550 is for biopsy of deep neck or thorax soft tissue.
Compare 21550 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
Indiana →
Office / nonfacility
$252.64
Facility
$133.74
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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 21550 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
2,001
- Code
- 21550
- Physician work
- 2.06
- Practice expense
- 5.78
- Malpractice
- 0.30
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.06 | × 1.000 | 2.0600 |
| Practice expense | 5.78 | × 0.927 | 5.3581 |
| Malpractice | 0.30 | × 0.486 | 0.1458 |
| Total RVUs | 7.5639 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Indiana$252.64
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.06 | 1 |
| Practice expense | 5.78 | 0.927 |
| Malpractice | 0.3 | 0.486 |
(2.06 × 1 + 5.78 × 0.927 + 0.3 × 0.486) × $33.4009 = $252.64
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.06 | 1 |
| Practice expense | 1.94 | 0.927 |
| Malpractice | 0.3 | 0.486 |
(2.06 × 1 + 1.94 × 0.927 + 0.3 × 0.486) × $33.4009 = $133.74
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.
21550 billing questions
How does this differ from a neck tumor excision code?
Use 21550 when the procedure samples deep soft tissue for diagnosis. When the surgeon removes a neck lesion or tumor, consider the applicable excision code instead.
Can modifier 50 be used for biopsies on both sides?
No. Modifier 50 is inappropriate for this descriptor and anatomy.
Are related postoperative visits separately paid during the global period?
Related postoperative visits during the 10-day global period are included in the procedure payment.
How is this code affected when another procedure is performed in the same session?
The highest-valued procedure is paid in full; other procedures in the same session are subject to the standard multiple-procedure reduction.
Can an assistant surgeon or co-surgeon be reported?
CMS does not pay an assistant at surgery for this code. Co-surgeon and team-surgery reporting 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.
1,99821501,,I&d dp absc/hmtma sft ts nck,A,,3.88,10.79,,5.10,,0.83,15.50,9.81,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,99921502,,I&d dp abs/hmtm nck rib ostc,A,,7.36,6.11,NA,6.11,,1.85,15.32,15.32,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,00021510,,Inc deep opng b1 crtx thorax,A,,6.05,6.30,NA,6.30,,1.51,13.86,13.86,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,00121550,,Biopsy of neck/chest,A,,2.06,5.78,,1.94,,0.30,8.14,4.30,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,00221552,,Exc neck les sc 3 cm/>,A,,6.33,5.02,NA,5.02,,1.50,12.85,12.85,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,00321554,,Exc neck tum deep 5 cm/>,A,,10.85,7.14,NA,7.14,,2.39,20.38,20.38,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,00421555,,Exc neck les sc < 3 cm,A,,3.86,9.17,,4.23,,0.82,13.85,8.91,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915