$371.21–$411.78
21011 describes a small tumor in the subcutaneous plane. Use 21013 when the tumor lies beneath the fascia, including within muscle.
On this page
CMS RVU26D · Effective 2026-10-01
21013 Tumor excision Medicare reimbursement rates in Pennsylvania
Reports removal of a small soft-tissue tumor beneath the fascia of the face or scalp, including deep or intramuscular lesions. Compare 21013 office and facility rates across CMS payment localities in Pennsylvania.
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 21013 in Pennsylvania?
Pennsylvania 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
$534.45–$589.58
2 of 2 localities have a supported rate.
Facility setting
$356.61–$387.91
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.
Head and neck surgery
About 21013: Deep facial soft-tissue tumor excision
Reports removal of a small soft-tissue tumor beneath the fascia of the face or scalp, including deep or intramuscular lesions.
This code describes excision of a soft-tissue tumor beneath the fascia in the face or scalp, including a lesion within muscle, when the tumor is smaller than 2 cm. The surgeon removes the deep mass rather than a superficial skin or subcutaneous lesion. Otolaryngologists, plastic surgeons, and oral and maxillofacial surgeons may perform this procedure in an operating room or an appropriately equipped outpatient setting.
Select the code using the tumor’s depth and size, not the skin incision length: the operative report should identify the facial or scalp site, the tissue plane or muscle involved, and the tumor measurement. This major surgery has a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Assistant-at-surgery services may be paid; co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 21013
- 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 not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU5.28 · 31%
- Practice expense (office) RVU10.67 · 63%
- Malpractice RVU0.98 · 6%
630
Medicare services in 2024 · #3351 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.
21013 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
No office rate
Both codes describe deep facial or scalp soft-tissue tumors; 21013 is for tumors under 2 cm, while 21014 is for tumors 2 cm or larger.
No office rate
21015 describes radical resection of a face or scalp soft-tissue tumor. Use 21013 for excision of a deep tumor under 2 cm when radical resection is not performed.
Compare 21013 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
Metropolitan Philadelphia →
Office / nonfacility
$589.58
Facility
$387.91
Rest Of Pennsylvania →
Office / nonfacility
$534.45
Facility
$356.61
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21013 billing questions
How is this code distinguished from a superficial facial lesion excision?
Use this code for a tumor beneath the fascia, including an intramuscular mass, that is under 2 cm. A lesion limited to the subcutaneous plane belongs to the superficial-lesion code family.
Which size measurement supports code selection?
Document the tumor measurement and its tissue depth in the operative report. The 2 cm threshold concerns the tumor, not the incision.
Does the code include the related postoperative visits?
Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How are other procedures paid when performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction, with payment at 50%.
Can an assistant surgeon or co-surgeon be reported?
Assistant-at-surgery services may be paid. CMS does not permit co-surgeon or team-surgery billing 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 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.
1,83621010,,Incision of jaw joint,A,,10.76,7.82,NA,7.82,,1.56,20.14,20.14,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,83721011,,Exc face les sc <2 cm,A,,2.92,8.38,,4.04,,0.53,11.83,7.49,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,83821012,,Exc face les sbq 2 cm/>,A,,4.34,4.45,NA,4.45,,0.91,9.70,9.70,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,83921013,,Exc face tum deep < 2 cm,A,,5.28,10.67,,4.87,,0.98,16.93,11.13,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,84021014,,Exc face tum deep 2 cm/>,A,,6.95,6.11,NA,6.11,,1.32,14.38,14.38,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,84121015,,Resect face/scalp tum < 2 cm,A,,9.64,7.82,NA,7.82,,1.69,19.15,19.15,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,84221016,,Resect face/scalp tum 2 cm/>,A,,14.88,9.36,NA,9.36,,2.75,26.99,26.99,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00