Summary & Overview
CPT 24076: Excision of Subfascial/Intramuscular Tumor, Upper Arm/Elbow (<5 cm)
CPT code 24076 denotes surgical excision of a soft tissue tumor under 5 cm situated in the subfascial or intramuscular region of the upper arm and elbow. This code captures a specific orthopedic/plastic surgical service focused on removal of localized masses within deep soft tissues of the proximal upper extremity. Nationally, accurate coding for these procedures affects procedural tracking, quality measurement, and appropriate surgical reimbursement for limb-sparing soft tissue tumor management.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, common billing modifiers, and the payer mix considered. The publication also outlines benchmarks and policy-relevant points for claims processing and documentation, and highlights areas where coding specificity—such as tumor size and depth—affects code selection. The summary provides guidance on what to expect in payer coverage approaches and administrative handling without prescribing clinical actions. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 24076 describes the surgical removal of a tumor less than 5 cm located in the subfascial or intramuscular tissue of the upper arm and elbow region. This procedure involves excision of a localized soft tissue mass beneath the fascia or within muscle layers of the proximal upper extremity.
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Service type: Surgical excision of soft tissue tumor of the upper arm/elbow
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Typical site of service: Hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient presents with a palpable, enlarging, painless mass deep in the lateral upper arm. Imaging with MRI demonstrates a well-circumscribed 3.2 cm intramuscular lesion located beneath the fascia of the deltoid/upper arm region suspicious for a benign soft-tissue tumor (e.g., lipoma or benign peripheral nerve sheath tumor). The patient is scheduled for operative excision under general anesthesia in an ambulatory surgery center. The surgical team performs a longitudinal incision over the mass, dissects through subcutaneous tissue and fascia, and identifies the tumor within muscle. The surgeon achieves en bloc resection with margin control, obtains hemostasis, and sends the specimen for pathology. Intraoperative documentation includes tumor size (<5 cm), subfascial/intramuscular location, estimated blood loss, anesthesia time, personnel (surgeon, assistant), laterality, and any complications. Postoperative care includes short-term observation in PACU, discharge instructions for wound care, pain control, and follow-up for pathology results and wound check within 7–14 days. Typical payors involved include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | Use when the procedure was performed on the left upper arm/elbow region |