Summary & Overview
CPT 21930: Excision of Soft-Tissue Mass <3 cm, Back or Flank
CPT code 21930 represents excision of a small (less than 3 cm) soft-tissue tumor or mass located in the posterior trunk or flank, with submission of the specimen for pathologic analysis. This procedure is commonly performed to obtain a definitive diagnosis when imaging or clinical exam raises concern for malignancy or symptomatic benign lesions. Nationally, accurate coding of soft-tissue excisions influences surgical case mix, pathology workload, and payment for outpatient surgical services.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and the service type represented by this code. The publication also summarizes common billing considerations, expected documentation elements for pathology submission, and comparative benchmarks where available.
The piece provides guidance on interpreting the code in clinical workflows, outlines what drives utilization (clinical indications such as suspected malignancy or symptomatic lesions), and highlights areas where policy updates or payer-specific edits commonly affect claims. Data not available in the input includes payer-specific rates, associated taxonomies, and ICD-10 diagnosis pairings.
Billing Code Overview
CPT code 21930 describes the surgical removal of a small soft-tissue mass or tumor less than 3 cm located in the posterior trunk (back) or flank. The procedure includes excision of the lesion with submission of the specimen for pathological analysis to determine the presence of abnormal or malignant cells.
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Service type: Surgical excision of soft tissue mass
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Typical site of service: Outpatient surgical suite, ambulatory surgery center, or hospital operating room
Clinical & Coding Specifications
Clinical Context
A 54-year-old patient presents to an outpatient surgical clinic with a painless, palpable soft-tissue mass on the left flank that has slowly enlarged over several months. The surgeon performs a focused history and exam, obtains informed consent, and schedules an excision under local anesthesia with sedation in an ambulatory surgical center. Pre-procedure steps include verification of the lesion location, marking, and preparing sterile instruments. Intra-procedure, the surgeon makes a small incision, dissects through subcutaneous tissues, and removes a solitary soft-tissue mass measuring less than 3 cm in greatest dimension from the posterior trunk. The specimen is placed in formalin and sent to pathology for histologic analysis to evaluate for benign versus malignant features. Hemostasis is achieved, the wound is irrigated, and the incision is closed. Post-procedure, the patient receives wound-care instructions and arrangements for pathology follow-up and further oncologic referral if malignancy is identified.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Procedure or service not classified elsewhere | Rarely used; applicable only if payer requires a general unlisted modifier for administrative reasons. |
11 |