No office rate
Both describe radical resection in the neck or anterior thorax; 21557 is for tumors under 5 cm, while 21558 is for tumors 5 cm or larger.
On this page
CMS RVU26D · Effective 2026-10-01
21558 Tumor resection Medicare reimbursement rates in Virginia
Radical resection of a soft-tissue tumor in the neck or anterior thorax measuring at least 5 cm, typically for definitive oncologic treatment. Compare 21558 office and facility rates across CMS payment localities in Virginia.
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 21558 in Virginia?
Virginia 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
$1171.02–$1341.98
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.
Surgical oncology
About 21558: Radical neck or anterior thorax tumor resection
Radical resection of a soft-tissue tumor in the neck or anterior thorax measuring at least 5 cm, typically for definitive oncologic treatment.
This service covers radical removal of a soft-tissue tumor, such as a sarcoma, in the neck or anterior thorax when the tumor is at least 5 cm. It represents a more extensive oncologic resection than a limited excision or diagnostic biopsy. Head and neck or surgical oncology surgeons commonly perform it in an operating room, with the operative approach and extent guided by the tumor’s location and treatment plan.
Report the code when the operative record supports radical resection and identifies the anatomic site, tumor size, and extent of removal. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. For other procedures performed in the same session, the highest-valued procedure is paid in full and additional procedures are subject to the standard 50% multiple procedure reduction. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted. Modifier 50 is inappropriate for this code.
CMS billing rules for 21558
- 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 RVU21.04 · 58%
- Practice expense (office) RVU11.03 · 30%
- Malpractice RVU4.50 · 12%
650
Medicare services in 2024 · #3329 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.
21558 compared with similar codes
Office rates for Virginia, from the same CMS release.
No office rate
Use 21554 for a deep neck tumor at least 5 cm when the documented procedure is an excision, rather than the radical resection represented by 21558.
$265.66–$311.10
21550 describes biopsy of a neck or chest lesion. It is for diagnostic tissue sampling, not definitive radical tumor resection.
Compare 21558 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
Dc + Md/Va Suburbs →
Office / nonfacility
Unavailable
Facility
$1341.98
Virginia →
Office / nonfacility
Unavailable
Facility
$1171.02
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21558 billing questions
How is 21558 different from 21554?
Both concern a deep neck tumor at least 5 cm, but 21558 is for radical resection. Use 21554 for the applicable deep-tumor excision when the documented operation is not a radical resection.
Does the tumor need to measure at least 5 cm?
Yes. This code is for a tumor measuring 5 cm or larger; 21557 is the related radical-resection code for tumors under 5 cm.
What documentation supports reporting 21558?
The operative report should identify the neck or anterior thorax site, tumor size, and the extent of the radical resection. Documentation should distinguish the operation from a limited excision or biopsy.
Can an assistant surgeon be reported?
CMS permits payment for an assistant at surgery with this code. Co-surgeon payment requires supporting documentation.
Can modifier 50 be used for bilateral tumors?
No. The code’s descriptor or anatomy makes modifier 50 inappropriate.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and related postoperative care for 90 days are included in the global period.
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.
2,00421555,,Exc neck les sc < 3 cm,A,,3.86,9.17,,4.23,,0.82,13.85,8.91,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,00521556,,Exc neck tum deep < 5 cm,A,,7.47,5.76,NA,5.76,,1.48,14.71,14.71,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,00621557,,Resect neck thorax tumor<5cm,A,,14.38,8.92,NA,8.92,,3.12,26.42,26.42,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,00721558,,Resect neck tumor 5 cm/>,A,,21.04,11.03,NA,11.03,,4.50,36.57,36.57,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,00821600,,Partial removal of rib,A,,7.08,8.24,NA,8.24,,1.68,17.00,17.00,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,00921601,,Exc chest wall tumor w/ribs,A,,17.34,11.50,NA,11.50,,4.44,33.28,33.28,0,090,0.10,0.71,0.19,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,01021602,,Exc ch wal tum w/o lymphadec,A,,21.64,18.83,NA,18.83,,5.31,45.78,45.78,0,090,0.10,0.71,0.19,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00