Summary & Overview
CPT 27041: Deep Pelvic/Hip Soft-Tissue Biopsy, Intramuscular/Subfascial
CPT code 27041 represents a deep subfascial or intramuscular soft-tissue biopsy of the pelvis and hip area used to obtain tissue for histopathologic diagnosis of malignant, benign, or precancerous conditions. This code captures procedures performed when superficial sampling is insufficient and when imaging- or palpation-guided access to deep pelvic or hip musculature is required. Nationally, accurate coding for deep soft-tissue biopsies supports appropriate clinical documentation, care coordination among specialists, and correct claims adjudication for complex diagnostic procedures.
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 use of CPT code 27041, typical settings where the service is delivered, and considerations that commonly affect coding and billing for deep soft-tissue biopsies. The publication summarizes national benchmarking elements, common modifiers associated with procedural episodes, and relevant policy or payer considerations where available. It is intended to orient clinicians, coding professionals, and policy analysts to the procedural definition, billing implications, and areas where additional documentation or payer-specific policies may influence coverage and reimbursement outcomes.
Billing Code Overview
CPT code 27041 describes a biopsy of deep subfascial or intramuscular soft tissue of the pelvis and hip area performed to establish whether tissue is malignant, benign, or precancerous. The procedure involves obtaining a tissue specimen from deep soft-tissue structures beneath the fascia or within muscle of the pelvic/hip region for diagnostic histopathology.
Service Type: Deep soft-tissue biopsy (pelvis/hip)
Typical Site of Service: Hospital outpatient department, ambulatory surgery center, or specialized procedural suite
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient presents with a deep, gradually enlarging mass in the lateral hip/pelvic region noted on clinical exam and cross-sectional imaging (MRI) showing a 4.5 cm intramuscular lesion suspicious for sarcoma. The orthopedic oncologist and interventional radiologist coordinate care. After review of imaging and discussion at a tumor board, the patient is scheduled for a deep subfascial/intramuscular core-needle biopsy of the pelvic/hip soft tissue under conscious sedation or monitored anesthesia care in an outpatient procedure suite or ambulatory surgery center. The procedural workflow includes pre-procedure consent and coagulation assessment, image guidance (ultrasound or CT) to target the lesion while avoiding neurovascular structures, multiple core samples obtained for histopathology and ancillary studies (immunohistochemistry, molecular testing), specimen labeling and submission to pathology, and post-procedure observation for hemostasis and neurovascular status prior to discharge. The typical site of service is an outpatient hospital outpatient department, ambulatory surgery center, or interventional radiology suite.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 | Distinct Procedural Service | When biopsy is performed at a distinct anatomic site from another procedure on the same date. |
26 |