$493.60–$517.80
Both describe subcutaneous hip or pelvic lesion excision; the size boundary is 3 cm, with 27043 for lesions at or above it and 27047 below it.
On this page
CMS RVU26D · Effective 2026-10-01
27043 Soft-tissue excision Medicare reimbursement rates in Maine
Reports surgical removal of a subcutaneous soft-tissue mass in the hip or pelvis area when the lesion measures 3 cm or larger. Compare 27043 office and facility rates across CMS payment localities in Maine.
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 27043 in Maine?
Maine has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$419.11–$432.01
2 of 2 localities have a supported rate.
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 27043: Hip and pelvis subcutaneous mass excision
Reports surgical removal of a subcutaneous soft-tissue mass in the hip or pelvis area when the lesion measures 3 cm or larger.
This service removes a soft-tissue mass beneath the skin in the hip or pelvic region, such as a sizable superficial lipoma. Orthopedic, general, or surgical oncology surgeons may perform it in an outpatient operating room or, for appropriate lesions, an office procedure setting. The target is subcutaneous tissue; a mass arising in deeper tissue or bone is not selected by superficial location alone.
Select the code using the lesion’s documented size and tissue depth, not the length of the incision. The operative note should identify the hip or pelvic site, confirm the subcutaneous plane, record the lesion measurement, and describe its removal. A diagnostic sample without excision is a biopsy service instead. CMS 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 others at 50%. Modifier 50 bilateral reporting is paid at 150%; assistant-at-surgery payment is restricted, and co-surgery and team surgery are not permitted.
CMS billing rules for 27043
- 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 RVU6.71 · 49%
- Practice expense (office) RVU5.23 · 38%
- Malpractice RVU1.65 · 12%
1.3K
Medicare services in 2024 · #2758 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.
27043 compared with similar codes
Office rates for Maine, from the same CMS release.
No office rate
Use 27045 for a deep soft-tissue tumor measuring 5 cm or larger. This code is for a subcutaneous lesion and uses a 3 cm threshold.
No office rate
Use 27048 for a deep soft-tissue tumor below 5 cm. A subcutaneous lesion measuring 3 cm or larger is classified with 27043.
$318.00–$334.63
27040 is a soft-tissue biopsy service; 27043 describes excision of the subcutaneous lesion rather than sampling it for diagnosis.
Compare 27043 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.
2 of 2 payment localities
Rest Of Maine →
Office / nonfacility
Unavailable
Facility
$419.11
Southern Maine →
Office / nonfacility
Unavailable
Facility
$432.01
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27043 billing questions
How is 27043 distinguished from 27047?
Both concern subcutaneous soft-tissue lesions in the hip or pelvic area. Use 27043 for a lesion measuring 3 cm or larger and 27047 for one measuring less than 3 cm.
When is a deep-lesion code more appropriate?
Choose based on the operative depth, not simply the skin incision or the lesion’s proximity to the hip. Deep soft-tissue lesions are classified separately, with the size boundary differing from this subcutaneous code.
Can this code be reported for a biopsy?
This code represents excision of the lesion, rather than removal of only a diagnostic sample. When the surgeon samples tissue without excising the mass, use the applicable soft-tissue biopsy code.
What size and site details should the operative note include?
Document the hip or pelvic location, that the mass was in the subcutaneous plane, and its measured size. The measurement supports choosing this code rather than the smaller-lesion sibling.
How is bilateral excision handled under the CMS rules?
For bilateral procedures, CMS pays modifier 50 reporting at 150%. The 90-day global period includes the day-before preoperative visit and related postoperative care.
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.
2,71927036,,Capsulectomy/capsulotomy hip,A,,14.02,11.24,NA,11.24,,2.97,28.23,28.23,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,72027040,,Biopsy of soft tissues,A,,2.85,6.96,,2.19,,0.43,10.24,5.47,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,72127041,,Biopsy of soft tissues,A,,9.93,7.67,NA,7.67,,2.01,19.61,19.61,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,72227043,,Exc hip pelvis les sc 3 cm/>,A,,6.71,5.23,NA,5.23,,1.65,13.59,13.59,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,72327045,,Exc hip/pelv tum deep 5 cm/>,A,,10.85,7.43,NA,7.43,,2.43,20.71,20.71,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,72427047,,Exc hip/pelvis les sc < 3 cm,A,,4.82,10.06,,4.58,,1.13,16.01,10.53,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,72527048,,Exc hip/pelv tum deep < 5 cm,A,,8.63,6.93,NA,6.93,,2.01,17.57,17.57,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00