CPT 27049 Pelvic/Hip Tumor Excision Reimbursement | OpenPayer

Summary & Overview

CPT 27049: Pelvic/Hip Soft-Tissue Tumor Excision, <5 cm

CPT code 27049 represents an extensive surgical excision of a suspected malignant soft-tissue tumor in the pelvis or hip, removing the lesion and surrounding tissue when the combined tumor and margin diameter is under 5 cm. This oncologic procedure is clinically significant because it addresses limb- and function-preserving cancer management in anatomically complex regions where margin status and tissue preservation are critical. Nationally, accurate coding for these procedures affects surgical quality reporting, claims adjudication, and resource utilization for complex surgical oncology care.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context and service setting for 27049, followed by benchmarks and policy-relevant information affecting coverage and claims processing. The content outlines typical service lines and billing considerations, highlights common clinical scenarios for use of the code, and points to areas where payers and providers commonly align or differ on authorization and documentation requirements. Data not available in the input is noted where applicable, and the publication focuses on nationally relevant implications for coding, billing, and clinical documentation.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 27049soft-tissue tumor excisionsurgical oncologypelvis and hip surgeryoncologic excisionoperative codinghospital outpatient surgeryambulatory surgical center

Billing Code Overview

CPT code 27049 describes an extensive excision of a tumor or mass in the soft tissues of the pelvis and hip region when malignancy (for example, a sarcoma) is suspected. The procedure includes removal of the mass along with surrounding soft tissues, with the combined diameter of the tumor and margins measuring less than 5 cm.

Service type: Major soft-tissue oncologic excision
Typical site of service: Hospital operating room or ambulatory surgical center for surgical oncology procedures

Clinical & Coding Specifications

Clinical Context

A 52-year-old patient presents with a deep soft-tissue mass in the proximal lateral thigh/pelvic soft tissues that is suspicious for a sarcoma based on imaging (MRI with contrast) and core needle biopsy findings. The surgical oncology team schedules an operative procedure for an en bloc wide local excision of the tumor with surrounding soft-tissue margins because malignancy is suspected and the lesion measures less than 5 cm in greatest diameter. The typical workflow includes preoperative staging (imaging, biopsy review), multidisciplinary tumor board review, informed consent documenting intent for wide local excision, intraoperative specimen orientation and margin marking, possible intraoperative frozen section consultation, and postoperative pathology with margin assessment. Typical site of service is the hospital operating room; ambulatory surgical centers may be used if resources and perioperative needs are appropriate. Perioperative coding will reflect an extensive excision of a pelvic/hip soft-tissue mass, anesthesia services, possible pathology (frozen and permanent), and postoperative follow-up visits.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the work, time, and/or intensity substantially exceed the usual for `27049` due to extensive dissection or intraoperative complexity.

CPT 27077: Radical Resection of Innominate Bone Tumor

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

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

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

CPT 27040: Superficial Soft Tissue Biopsy of Pelvis and Hip

CPT-27060-ISCHIAL-BURSA-EXCISION

CPT 27060: Excision of Ischial Bursa

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-27054-OPEN-HIP-SYNOVECTOMY

CPT 27054: Open Synovectomy of Hip

CPT-27080-COCCYGECTOMY-REMOVAL-OF-TAIL-BONE

CPT 27080: Coccygectomy, Removal of Coccyx

CPT-27062-TROCHANTERIC-BURSA-EXCISION

CPT 27062: Excision of Trochanteric Bursa

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

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

CPT-27075-RADICAL-RESECTION-PELVIC-BONE-TUMOR

CPT 27075: Radical Resection of Pelvic Bone Tumor

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Taxonomy Code	Specialty	Notes
207P00000X	General Surgery	General surgeons with oncologic training may perform wide local excision of soft-tissue tumors in the pelvis/hip.
2080P0005X	Surgical Oncology	Surgical oncologists frequently perform complex soft-tissue tumor resections and coordinate multidisciplinary care.
207L00000X	Orthopaedic Surgery	Orthopaedic oncologists perform resections of musculoskeletal soft-tissue sarcomas in pelvic/hip regions.
2086S0122X	Plastic and Reconstructive Surgery	Plastic surgeons provide complex soft-tissue reconstruction or flap coverage following wide excision when needed.
207T00000X	Thoracic Surgery	Included for completeness in multidisciplinary teams when adjacent structures require thoracic input (rare for pelvic site).

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C49.A1`	Malignant neoplasm of soft tissue of pelvis	Soft-tissue sarcoma of the pelvic/hip region; primary indication for an en bloc wide excision coded by `27049`.
`C49.2`	Malignant neoplasm of connective and soft tissue of lower limb, including hip	Primary malignant soft-tissue tumors of the hip/upper thigh; directly relevant to `27049`.
`D48.1`	Neoplasm of uncertain behavior of connective and soft tissue	Lesions with uncertain malignant potential that may prompt wide excision for diagnosis and treatment.
`M79.1`	Myalgia	Symptom code sometimes recorded for patients presenting with pain at the tumor site; adjunctive, not primary.
`R22.42`	Localized swelling, mass and lump, pelvis	Symptom/manifestation code often used to document presenting complaint that led to imaging and excision.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11042`	Debridement; subcutaneous tissue (includes epidermis and dermis, if performed) first 20 sq cm or less	May be used if significant debridement of superficial tissues is performed at the excision site or for postoperative wound management.
`19307`	Partial mastectomy, partial mastectomy with axillary node dissection (example breast — unrelated anatomically)	Data not available in the input.
`88305`	Surgical pathology, gross and microscopic examination	Used for permanent histopathologic evaluation of the excised mass and margins after `27049`.
`88342`	Immunohistochemistry, per single antibody stain	Used when immunohistochemical stains are required to classify sarcoma subtype from the resection specimen.
`11000`	Debridement of open wounds, first 20 sq cm	May be applicable for wound management in the postoperative period for complex soft-tissue excisions.
`14301`	Adjacent tissue transfer or rearrangement, trunk (e.g., local flap), 30.1 sq cm to 60.0 sq cm	Used when local flap or reconstruction is required immediately following the wide excision in the pelvic/hip soft tissues.

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