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CPT 27323: Excisional Biopsy of Superficial Soft Tissue, Thigh or Knee
CPT code 27323 covers excisional biopsy of suspicious superficial soft tissue in the thigh or knee, a localized surgical procedure that yields tissue for laboratory analysis to establish diagnosis. This code is nationally relevant because soft-tissue masses and suspicious lesions often require histologic evaluation to guide treatment, affecting surgical, oncologic, and pathology workflows and payment policy nationwide. Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise briefing on clinical context and typical settings for the service, national coverage considerations, commonly used modifiers and billing nuances, and benchmarking data where available. The publication outlines typical sites of service—outpatient surgical suites, ambulatory surgery centers, and hospital outpatient departments—and highlights coding relationships and potential billing pitfalls. It also summarizes common payer approaches to coverage and payment for soft-tissue excisional biopsies, and points readers to where they can find further policy and documentation guidance. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 27323 describes a provider-performed excisional biopsy of suspicious superficial soft tissue of the thigh or knee, in which a tissue sample is removed and submitted to a laboratory for diagnostic analysis. The primary clinical purpose is to obtain tissue for histopathologic evaluation to determine the nature of a suspicious lesion.
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Service type: Surgical biopsy / excisional soft tissue procedure
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Typical site of service: Outpatient surgical suite, ambulatory surgery center, or hospital outpatient department