Summary & Overview
CPT 27040: Superficial Soft Tissue Biopsy of Pelvis and Hip
CPT code 27040 denotes a surgical biopsy of superficial soft tissue in the pelvis and hip region, performed to obtain tissue for histologic evaluation to determine benign, malignant, or precancerous status. Nationally, this code captures a common diagnostic surgical service that supports cancer diagnosis, treatment planning, and referral decisions across multiple care settings.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for the procedure, typical sites of service where it is performed, and commonly associated billing modifiers (input provided). The publication provides benchmarks and payer coverage considerations where available, highlights coding and billing nuances relevant to surgical biopsy services, and summarizes policy updates that commonly affect diagnostic surgical procedures.
The content is intended for billing professionals, clinical coders, revenue cycle leaders, and policy analysts seeking a concise reference on CPT code 27040, its clinical purpose, and typical billing context. Data not available in the input will be noted as such in relevant sections.
Billing Code Overview
CPT code 27040 describes a biopsy of superficial soft tissue of the pelvis and hip area. The procedure involves obtaining a tissue sample from superficial soft tissues in the pelvic or hip region to determine whether cells are benign, malignant, or precancerous.
Service Type: Surgical biopsy; diagnostic surgical procedure
Typical Site of Service: Ambulatory surgical center, hospital outpatient department, or physician office with minor procedure capabilities
Clinical & Coding Specifications
Clinical Context
A 54-year-old patient presents to an outpatient surgical clinic with a 2-cm, palpable, gradually enlarging soft tissue mass located over the lateral hip. The mass is tender to palpation and has persisted despite conservative measures. Imaging (ultrasound or MRI) demonstrates a superficial soft-tissue lesion in the subcutaneous tissue over the greater trochanter without deep extension. The orthopedic surgeon or general surgeon schedules a planned outpatient biopsy of the superficial pelvic/hip soft tissue to obtain histologic diagnosis.
Clinical workflow:
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Pre-procedure evaluation and consent completed in clinic, with review of imaging and risk discussion.
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Site marking and time-out performed on day of procedure in an ambulatory surgical center or hospital outpatient department.
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Local anesthesia or monitored anesthesia care provided depending on complexity and patient comorbidity.
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Excisional or incisional biopsy performed; specimen oriented and submitted to pathology with relevant clinical history.
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Post-procedure wound care instructions provided; specimen result follow-up arranged with pathology and clinic.
Typical site of service: Ambulatory Surgical Center (ASC) or Hospital Outpatient Department for a planned biopsy. Service type: Minor surgical procedure—superficial soft tissue biopsy of the pelvis/hip area.
Coding Specifications
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