Billing code 21935: Tumor resectionMedicare rate & RVUs in Utah
Reports radical removal of a soft-tissue tumor in the back or flank measuring under 5 cm, typically when an oncologic operation requires wider tissue removal.
CMS doesn’t publish an office rate for 21935 in Utah.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 21935 covers
This code describes a radical operation to remove a soft-tissue tumor in the back or flank that measures less than 5 cm. Unlike a limited excision, the procedure involves a wider removal of tumor and surrounding soft tissue for oncologic treatment, such as management of a soft-tissue sarcoma. A surgeon performs it in an operative setting; the operative report should make the location, tumor size, and extent of resection clear.
Report the code when the documented operation is radical, not simply because a mass is deep or requires an incision. Distinguish it from biopsy and less extensive excision codes, and support the size threshold and resection extent in the record. Medicare 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 other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment is restricted; co-surgeons are paid only with supporting documentation, and team surgery is not permitted.
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.
21935 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | Unavailable | $924.24 |
How the 21935 rate is calculated
Each of 21935’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 21935
RVUs × geographic indexes × conversion factor
Work15.33
15.33 RVUs× 1.000 GPCI
Practice expense9.68
9.68 RVUs× 1.000 GPCI
Malpractice3.61
3.61 RVUs× 1.000 GPCI
Adjusted RVUs
28.6200
Conversion factor
$33.4009
Medicare rate
$955.93
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21935
21935 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21935
Tumor resection
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.69/0.21 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 21935
Tumor resection
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
21935 without 51 · national facility
$955.93
Tumor resection
21935-51 · Second procedure: 50%
$477.97
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
21935 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 21936Back tumor resection
- Use 21936 when the radical back or flank tumor resection is for a tumor measuring 5 cm or greater; 21935 is for one under 5 cm.
- 21932Back tumor excision
- Use 21932 for subfascial tumor excision without the radical oncologic extent represented by 21935.
- 21925Soft-tissue biopsy
- Use 21925 for deep diagnostic tissue sampling. Use 21935 when the documented service is radical removal of the tumor.
21935 billing questions
How is this code different from a simple back or flank tumor excision?
This code is for a radical oncologic resection, not a routine removal based only on the mass's location or depth. The operative report should support the wider extent of tissue removal.
Does a tumor under 5 cm qualify based on size alone?
No. The documented operation must be radical, and the tumor must meet the under-5-cm size threshold. Size alone does not distinguish this service from a less extensive excision.
Can a biopsy be reported instead for the same mass?
A biopsy code describes diagnostic tissue sampling, rather than definitive radical removal. Choose based on the service actually performed and documented.
Is modifier 50 appropriate for tumors on both sides of the back?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does the 90-day global period affect postoperative visits?
The global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeon payment requires supporting documentation; team surgery is 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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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