No office rate
This code is for a deep back or flank tumor resection measuring 5 cm or larger; 21935 is the corresponding resection code for a tumor under 5 cm.
On this page
CMS RVU26D · Effective 2026-10-01
21936 Back tumor resection Medicare reimbursement rates in Kentucky
Reports resection of a deep soft tissue tumor of the back or flank measuring at least 5 cm, such as a tumor beneath the fascia. Compare 21936 office and facility rates across CMS payment localities in Kentucky.
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 21936 in Kentucky?
Kentucky 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
$1248.86
1 of 1 localities have a supported rate.
Payment area: Kentucky
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.
Soft tissue surgery
About 21936: Deep back tumor resection, 5 cm or larger
Reports resection of a deep soft tissue tumor of the back or flank measuring at least 5 cm, such as a tumor beneath the fascia.
This code describes operative resection of a large soft tissue tumor in the back or flank that lies beneath the fascia, including an intramuscular tumor. It is used for therapeutic removal, not for taking a diagnostic sample alone. Surgeons, including general and surgical oncology specialists, may perform the procedure in a hospital or other surgical setting. The operative report should establish the tumor’s deep location, size, and the resection performed.
Choose this code when the resected tumor is 5 cm or larger and the procedure meets the resection service represented by this code. Distinguish it from codes for smaller deep tumors, excision rather than resection, and superficial lesions; document the size and tissue plane. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. 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 not appropriate for this service. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 21936
- 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
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU21.99 · 56%
- Practice expense (office) RVU11.94 · 30%
- Malpractice RVU5.23 · 13%
393
Medicare services in 2024 · #3751 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.
21936 compared with similar codes
Office rates for Kentucky, from the same CMS release.
No office rate
Both concern a deep back or flank tumor at least 5 cm. Choose 21936 for a resection service and 21933 when the documented procedure is an excision.
$500.43
21925 reports a diagnostic biopsy of deep back soft tissue. This code reports resection of a large deep tumor, not sampling alone.
No office rate
21931 concerns excision of a subcutaneous back or flank lesion measuring 3 cm or larger. This code is for a deep tumor at least 5 cm and a resection service.
Compare 21936 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
Kentucky →
Office / nonfacility
Unavailable
Facility
$1248.86
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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 21936 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
2,040
- Code
- 21936
- Physician work
- 21.99
- Practice expense
- 11.94
- Malpractice
- 5.23
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 21.99 | × 1.000 | 21.9900 |
| Practice expense | 11.94 | × 0.889 | 10.6147 |
| Malpractice | 5.23 | × 0.915 | 4.7855 |
| Total RVUs | 37.3901 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Kentucky$1248.86
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 21.99 | 1 |
| Practice expense | 11.94 | 0.889 |
| Malpractice | 5.23 | 0.915 |
(21.99 × 1 + 11.94 × 0.889 + 5.23 × 0.915) × $33.4009 = $1248.86
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.
21936 billing questions
How is this code distinguished from 21935?
Both describe resection of a deep back or flank tumor. Use 21936 for a tumor measuring 5 cm or larger and 21935 for one under 5 cm.
How does this differ from 21933?
21933 describes excision of a deep back or flank tumor measuring 5 cm or larger. Select between the codes based on the procedure actually performed and documented, not size alone.
Can a biopsy be reported with the resection?
A separate diagnostic biopsy is not represented by this resection code. Code 21925 describes biopsy of deep soft tissue of the back; report separate services only when independently performed and supported by the record.
What documentation supports code selection?
Document the tumor’s back or flank location, its relationship to the fascia or muscle, its size, and the resection performed. The record should support the distinction from a superficial or smaller tumor service.
Can modifier 50 be used for tumors on both sides?
No. Modifier 50 is not appropriate for this back or flank tumor resection.
How does the multiple-procedure reduction affect payment?
When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the other procedures are subject to the standard 50% reduction.
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.
2,03721932,,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
2,04322100,,Remove part of neck vertebra,A,,10.73,14.53,NA,14.53,,4.51,29.77,29.77,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631