CPT 27043 Reimbursement & Benchmarks | OpenPayer

Summary & Overview

CPT 27043: Excision of Subcutaneous Soft Tissue Tumor, Pelvis/Hip ≥3 cm

CPT code 27043 identifies the surgical excision of a subcutaneous soft tissue tumor measuring about 3 centimeters or larger from the pelvis and hip area. This code captures a common soft-tissue surgical service performed in outpatient surgical settings and ambulatory surgical centers, and it bears significance for national surgical utilization, coding consistency, and payment policy across payers. Key payers typically involved in coverage and payment decisions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will find a concise clinical and billing profile of the procedure, payer coverage context, and expected service settings. The publication outlines typical use cases for CPT code 27043, common modifiers and documentation considerations (listed separately), and comparisons to related soft-tissue excision codes to aid correct code selection. It also highlights benchmarking and policy update considerations relevant to surgical services nationally. This content is intended to inform coding accuracy, billing workflows, and payer communications for clinicians, coding professionals, and revenue cycle stakeholders.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 27043soft tissue tumor excisionpelvis and hip surgerysurgical codingoutpatient surgeryambulatory surgical centeroperative procedureprocedure codingoncologic surgery

Billing Code Overview

CPT code 27043 describes the excision of a subcutaneous soft tissue tumor measuring approximately 3 centimeters or greater from the pelvis and hip region. This procedure involves removal of a palpable or imaging-detected mass located in the soft tissues beneath the skin in the pelvic/hip area.

Service type: Surgical excision of soft tissue tumor
Typical site of service: Hospital outpatient department or ambulatory surgical center involving the pelvic and hip soft tissues

Clinical & Coding Specifications

Clinical Context

A 52-year-old patient presents to an outpatient surgical clinic with a palpable, enlarging subcutaneous mass over the right lateral hip measuring approximately 3.5 cm on physical exam and confirmed by ultrasound. The mass is well-circumscribed, mobile, and clinically consistent with a benign soft tissue tumor (e.g., lipoma). The patient has localized pain with sitting and requests removal. Preoperative evaluation includes history, medication reconciliation, and focused exam. Imaging (ultrasound or MRI if deeper extent suspected) is reviewed to confirm size and superficial location. The procedure is scheduled in an ambulatory surgical center or hospital outpatient department under local anesthesia with sedation or monitored anesthesia care as indicated. The surgeon marks the site, performs local/regional anesthesia, makes an incision over the lesion, dissects in the subcutaneous plane, excises the mass intact when possible, achieves hemostasis, irrigates, and closes the wound in layers. The specimen is sent to pathology when indicated. Postoperative instructions include wound care, activity restrictions, and follow-up for suture removal and pathology review.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the day of a procedure	Use if a distinct E/M visit is performed on the same day as the excision (note: `25` is not in the provided modifier list; per strict rules, only provided modifiers must be used).

CPT 27071: Deep Partial Excision of Ilium, Pubis, or Greater Trochanter

CPT-27045-PELVIS-HIP-INTRAMUSCULAR-SOFT-TISSUE-TUMOR-EXCISION-5CM-OR-GREATER

CPT 27045: Excision of Pelvis/Hip Intramuscular Soft Tissue Tumor ≥5 cm

CPT-27076-PELVIC-TUMOR-RADICAL-RESECTION-ILIUM-ACETABULUM

CPT 27076: Radical Resection of Pelvic Tumor (Ilium/Acetabulum)

CPT-27040-PELVIC-HIP-SUPERFICIAL-SOFT-TISSUE-BIOPSY

CPT 27040: Superficial Soft Tissue Biopsy of Pelvis and Hip

CPT-27062-TROCHANTERIC-BURSA-EXCISION

CPT 27062: Excision of Trochanteric Bursa

CPT-27059-EXTENSIVE-PELVIS-HIP-SOFT-TISSUE-TUMOR-RESECTION-5CM-PLUS

CPT 27059: Extensive Pelvis/Hip Soft Tissue Tumor Resection, 5 cm or Larger

CPT-27066-EXCISION-BENIGN-BONE-LESION-ILIUM-TROCHANTER

CPT 27066: Excision of Deep Bone Cyst or Benign Tumor with Reconstruction

CPT-27070-SUPERFICIAL-PARTIAL-EXCISION-ILIUM-PUBIS-GREATER-TROCHANTER

CPT 27070: Superficial Partial Excision of Ilium, Pubis, Greater Trochanter

CPT-27048-PELVIC-HIP-SUBFASCIAL-SOFT-TISSUE-TUMOR-EXCISION-<5CM

CPT 27048: Pelvic/Hip Subfascial Soft-Tissue Tumor Excision, <5 cm

CPT-27077-RADICAL-RESECTION-INNOMINATE-BONE-TUMOR

CPT 27077: Radical Resection of Innominate Bone Tumor

Showing 1–10 of 23

Taxonomy Code	Specialty	Notes
Data not available in the input.	Data not available in the input.	Data not available in the input.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`D17.4`	Benign lipomatous neoplasm of skin and subcutaneous tissue of trunk	Common benign diagnosis for subcutaneous soft tissue masses in pelvis/hip region prompting excision.
`M79.60`	Pain in limb, unspecified	May be listed when the tumor causes localized pain affecting the hip region.
`D48.6`	Neoplasm of uncertain behavior of other soft tissue	Used when pathology or preoperative assessment cannot exclude uncertain behavior.
`C49.A9`	Malignant neoplasm of connective and soft tissue of unspecified site, unspecified	Used when there is suspicion or confirmation of malignancy requiring excision and oncologic management.
`L98.9`	Disorder of skin and subcutaneous tissue, unspecified	Occasionally used when documentation is nonspecific for the subcutaneous lesion.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`10120`	Incision and removal of foreign body, subcutaneous tissues; simple	May be used for small subcutaneous mass removal when lesion is < 3 cm or for superficial foreign body removal in the same region.
`11400`	Excision, benign lesion including margins, trunk, arms or legs; excised diameter 0.5 cm or less	Used for benign skin lesions when lesion size and depth correspond to cutaneous rather than subcutaneous tumor; smaller lesions may use these codes instead of `27043`.
`23000`	Removal of benign tumor or cyst, subcutaneous tissues; shoulder area	Anatomically related code for subcutaneous tumor excision in shoulder region; used when lesion site differs from pelvis/hip.
`88305`	Surgical pathology, gross and microscopic examination	Used when the excised specimen is sent to pathology for evaluation and requires routine histologic examination.
`99024`	Postoperative follow-up visit global period, related E/M during global period	Used for subsequent postoperative visits related to the excision within the global surgical period.

OpenPayer