CPT 27059 Reimbursement & Benchmarks | OpenPayer

Summary & Overview

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

CPT code 27059 denotes an extensive surgical excision of a soft tissue tumor and surrounding tissues in the pelvis or hip region when the lesion measures 5 cm or greater. Nationally, this code captures high-complexity oncologic and reconstructive procedures that have implications for surgical resource use, perioperative care pathways, and facility-level scheduling. It is significant for hospitals, surgical centers, and payers because these procedures typically require multidisciplinary coordination, advanced perioperative planning, and potential inpatient recovery.

Key payers included in the discussion are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will gain a concise overview of the clinical context for use of CPT code 27059, including where the procedure is typically performed and the service type. The publication also outlines what to expect in related sections: national benchmark considerations for utilization, common billing modifiers and administrative notes (where available), and clinical factors that drive use of the code. Data not available in the input will be noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 27059soft tissue tumor resectionpelvis and hip surgeryoncologic surgerysurgical billingoperating room proceduresambulatory surgical centermajor resection

Billing Code Overview

CPT code 27059 describes extensive surgical removal of a soft tissue tumor and surrounding tissues of the pelvis and hip area measuring 5 cm or more. This procedure involves wide excision of a large soft tissue mass in the pelvic or proximal femoral region.

Service type: Major soft tissue tumor resection
Typical site of service: Inpatient or outpatient surgical setting, commonly performed in an operating room or ambulatory surgical center depending on patient condition and surgical complexity

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 62-year-old male presents with a progressively enlarging, firm, deep-seated soft tissue mass located in the left proximal thigh/pelvic girdle region. Preoperative magnetic resonance imaging demonstrates a well-defined 6.5 cm intramuscular mass abutting the iliopsoas and involving adjacent soft tissues without obvious distant metastasis. Core needle biopsy returns a high-grade soft tissue sarcoma. Multidisciplinary review (orthopedic oncology, surgical oncology, medical oncology, and radiation oncology) recommends wide local excision with negative margins.

The clinical workflow includes preoperative staging (imaging of the chest, abdomen, and pelvis as indicated), anesthesia evaluation, intraoperative tumor resection with en bloc removal of surrounding soft tissue and a margin of normal tissue, possible intraoperative frozen section margin assessment, placement of drains or reconstruction as required, and postoperative monitoring in PACU with planned pathology review for margin status. Postoperative care includes wound checks, pain control, and coordination with oncology for adjuvant therapy if indicated. Typical site of service is an inpatient or outpatient surgical center equipped for major soft tissue oncologic procedures of the pelvis/hip region.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the procedure requires substantially greater work than typical (e.g., unusually extensive dissection, reconstruction).

Related Codes

CPT-27050-OPEN-SACROILIAC-JOINT-BIOPSY

CPT 27050: Open Sacroiliac Joint Biopsy, Soft Tissue

CPT-27049-PELVIC-HIP-SOFT-TISSUE-TUMOR-EXCISION-<5CM

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

CPT-27052-HIP-OPEN-SOFT-TISSUE-BIOPSY

CPT 27052: Open Biopsy of Hip Soft Tissue

CPT-27060-ISCHIAL-BURSA-EXCISION

CPT 27060: Excision of Ischial Bursa

CPT-27043-PELVIC-HIP-SUBCUTANEOUS-SOFT-TUMOR-EXCISION-3CM-PLUS

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

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

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

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

CPT 27075: Radical Resection of Pelvic Bone Tumor

CPT-27047-PELVIC-HIP-SUBCUTANEOUS-SOFT-TISSUE-TUMOR-EXCISION-LESS-THAN-3CM

CPT 27047: Excision of Soft Tissue Tumor, Pelvis/Hip Subcutaneous <3 cm

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Taxonomy Code	Specialty	Notes
207D00000X	Orthopedic Surgery	Orthopedic oncologists commonly perform limb- and pelvis-based soft tissue tumor resections.
208000000X	General Surgery	Surgical oncologists or general surgeons with oncology focus perform complex pelvic soft tissue resections.
207L00000X	Plastic Surgery	Plastic and reconstructive surgeons provide soft tissue reconstruction and flap coverage when necessary.
2084P0800X	Surgical Oncology	Surgical oncologists coordinate resection and oncologic margins for sarcoma management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C49.2`	Malignant neoplasm of connective and soft tissue of pelvis	Common primary diagnosis indicating a soft tissue sarcoma in the pelvic region requiring wide excision.
`M79.20`	Pain in unspecified limb	Symptom code that may accompany a deep soft tissue mass in the hip/pelvic area prompting evaluation.
`D48.1`	Neoplasm of uncertain behavior of connective and other soft tissue	Used when biopsy shows uncertain malignant potential pending definitive pathology.
`C49.1`	Malignant neoplasm of connective and soft tissue of upper limb, including shoulder	Included when tumor involves proximal thigh/hip extension into shoulder girdle areas (rare overlap).
`C49.9`	Malignant neoplasm of connective and soft tissue, unspecified	Used when site unspecified or documentation lacks precise anatomic detail.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11042`	Debridement; subcutaneous tissue (includes epidermis and dermis, if performed) for larger wounds	May be used for postoperative wound debridement of infected or necrotic tissue following tumor resection.
`19307`	Removal of breast implant, partial or complete capsulectomy, or complex breast procedures — (note: not typically for pelvis)	Data not applicable to pelvic tumor resection; list included only if breast tissue procedures coincide (rare).
`27130`	Arthroplasty, acetabular and femoral prosthetic replacement (total hip arthroplasty)	May be performed if resection necessitates joint reconstruction or prosthetic placement after tumor removal.
`77012`	CT guidance for needle placement (for biopsy)	Often used preoperatively for image-guided core needle biopsy to establish diagnosis before definitive resection.
`88309`	Surgical pathology, gross and microscopic examination, more complex; e.g., entire lesion	Used for definitive pathology examination and margin assessment of the resected soft tissue tumor.