No office rate
Use 21015 for radical resection of a face or scalp soft-tissue tumor under 2 cm; 21016 is for tumors measuring 2 cm or greater.
On this page
CMS RVU26D · Effective 2026-10-01
21016 Tumor resection Medicare reimbursement rates in Utah
Report this service for radical resection of a soft-tissue tumor of the face or scalp when the tumor measures 2 cm or greater. Compare 21016 office and facility rates across CMS payment localities in Utah.
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 21016 in Utah?
Utah 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
$873.36
1 of 1 localities have a supported rate.
Payment area: Utah
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.
Head and neck surgery
About 21016: Radical soft-tissue tumor resection
Report this service for radical resection of a soft-tissue tumor of the face or scalp when the tumor measures 2 cm or greater.
This code describes radical removal of a soft-tissue tumor on the face or scalp measuring at least 2 cm. It is distinct from a routine local excision and is used when the surgeon performs a more extensive resection. Plastic surgeons, otolaryngologists, oral and maxillofacial surgeons, and surgical oncologists may perform the procedure in an operating room or another appropriate surgical setting. The code concerns soft tissue, not a tumor arising in facial bone.
Choose the code based on the documented radical extent, soft-tissue location, and tumor size; distinguish it from simple excision codes for subcutaneous or deeper tumors. The operative report should identify the site, size, tissue involved, and extent of resection. This major surgery has 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 other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be made; co-surgeons and team surgery are not permitted.
CMS billing rules for 21016
- 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 RVU14.88 · 55%
- Practice expense (office) RVU9.36 · 35%
- Malpractice RVU2.75 · 10%
1.4K
Medicare services in 2024 · #2712 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.
21016 compared with similar codes
Office rates for Utah, from the same CMS release.
No office rate
21014 is for excision of a deep or subfascial tumor at least 2 cm. Use 21016 when the operation is documented as radical resection.
No office rate
21012 applies to a subcutaneous tumor at least 2 cm; 21016 describes radical resection of a soft-tissue tumor of the face or scalp.
$551.69
21026 addresses excision of facial bone. Choose 21016 for a soft-tissue tumor rather than a lesion involving facial bone.
Compare 21016 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
Utah →
Office / nonfacility
Unavailable
Facility
$873.36
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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 21016 in Utah.
PPRRVU2026_Oct_nonQPP.csv
1,842
- Code
- 21016
- Physician work
- 14.88
- Practice expense
- 9.36
- Malpractice
- 2.75
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 14.88 | × 1.000 | 14.8800 |
| Practice expense | 9.36 | × 0.940 | 8.7984 |
| Malpractice | 2.75 | × 0.898 | 2.4695 |
| Total RVUs | 26.1479 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Utah$873.36
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 14.88 | 1 |
| Practice expense | 9.36 | 0.94 |
| Malpractice | 2.75 | 0.898 |
(14.88 × 1 + 9.36 × 0.94 + 2.75 × 0.898) × $33.4009 = $873.36
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.
21016 billing questions
How does this differ from 21015?
Both describe radical resection of a soft-tissue tumor of the face or scalp. Use 21016 when the tumor is 2 cm or greater and 21015 when it is less than 2 cm.
When is 21014 a better fit?
21014 describes excision of a deep or subfascial face or scalp tumor measuring 2 cm or greater. Choose 21016 when the documented procedure is a radical resection rather than that excision.
Can modifier 50 be appended for tumors on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code. Report the documented services without modifier 50.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are subject to a 50% reduction.
May an assistant or another surgeon be reported?
Assistant-at-surgery payment may be made. 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 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.
1,83921013,,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
1,84321025,,Excision of bone lower jaw,A,,9.78,14.06,,7.28,,1.31,25.15,18.37,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,84421026,,Excision of facial bone(s),A,,5.56,10.94,,6.07,,0.75,17.25,12.38,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,84521029,,Contour of face bone lesion,A,,8.18,14.83,,7.57,,1.35,24.36,17.10,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10104412,TX,15,GALVESTON,1.008,0.993,0.828
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985