CPT 21552
Updated 5/7/2025
Reviewed by Nathan Liu, MD

Excision of soft tissue lesion, neck or upper chest, ≥3 cm with pathology analysis

Description

This procedure involves the surgical removal of an abnormal soft tissue growth from the neck or upper chest, measuring 3 cm or more. The excised specimen is submitted for pathological examination to diagnose any underlying medical conditions.

Medicare Provider Reimbursement (PFS)

Facility Setting

Procedure Price$441.85
Limiting Charge$482.72
Patient Coinsurance (20%)$88.37

RVU Calculation Breakdown

Work RVU
6.49
Practice Expense RVU
5.67
Malpractice RVU
1.50
Total RVU
13.66
6.49 + 5.67 + 1.50 = 13.66
13.66 RVUs×$32.3465 Conversion Factor
$441.85

Non-Facility Setting

Procedure PriceN/A
Limiting ChargeN/A
Patient Coinsurance (20%)N/A
Not billable under PFS in non-facility setting

Medicare Patient Copayment

After meeting the annual Medicare deductible ($1676 per benefit period up to 60 days for inpatient stays under Part A and $257 for outpatient care under Part B in 2025), Medicare patients are typically responsible for 20% of the Medicare-approved amount as coinsurance. The amounts shown are estimates and may vary based on the patient's specific coverage and whether they have supplemental insurance.

Medicare Hospital Outpatient Reimbursement (OPPS)

OPPS Payment Rate

$2,862.05

Calculation:

x=$2,862.05

Patient Copayment / Coinsurance

$572.41

Calculation breakdown:

  • Minimum (20% of rate)$572.41
Medicare Ambulatory Surgical Center Reimbursement (ASC)

ASC Payment Rate

$1,201.90

Calculation:

x=$1,201.90

Patient Copayment / Coinsurance

$240.38

Standard copayment (20%):$240.38

Multiple procedure discount applies

When performed with other applicable procedures during the same session, this procedure may be subject to a payment reduction.

Top Modifiers

Graph View

List View

HCPCS/CPT 51Multiple procedures performed by the same provider(23.17%)
HCPCS/CPT ASServices by physician assistant, nurse practitioner, or clinical nurse specialist at surgery(9.3%)
HCPCS/CPT GCServices performed by a resident under the supervision of a teaching physician(7.67%)
HCPCS/CPT 59Distinct procedural service for non-E/M services(6.94%)
HCPCS/CPT LTModifier for procedures performed on the left side of the body(5.94%)
HCPCS/CPT RTRight side procedure modifier(5.2%)
HCPCS/CPT 79Unrelated procedure by the same physician during the postoperative period(3.36%)
HCPCS/CPT XSSeparate structure service on distinct organ or structure(1.89%)
HCPCS/CPT 80Assistant surgeon services during surgical procedures(1.05%)
HCPCS/CPT 58Staged or related procedure by the same physician during postoperative period(1.05%)
Code Crosswalks

No crosswalks found.

Alternate Codes

No alternates found.

Billed With Codes

No codes found here.

Sources

We make no claims to ownership of the coding systems referenced on this platform. Codes and descriptions are produced from claims and chargemaster data available through the CMS-9915-F Transparency in Coverage Final Rule and via state or federal datasets. This service is provided solely as a reference to encourage use of these codes in our chargemaster review and automated billing tools, so that healthcare professionals can understand and correctly report these codes in their claims.

Federal and State Datasets

  • List of CPT/HCPCS Codes, Centers for Medicare & Medicaid Services (CMS)
  • I/OCE Quarterly Release Files, Centers for Medicare & Medicaid Services (CMS)
  • Physician Fee Schedule Relative Value Files, Centers for Medicare & Medicaid Services (CMS)
  • OPPS Addendum B, Centers for Medicare & Medicaid Services (CMS)
  • ASC Payment Addenda, Centers for Medicare & Medicaid Services (CMS)