Summary & Overview
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.
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
Clinical & Coding Specifications
Clinical Context
A middle-aged patient presents to an outpatient orthopedic or dermatologic clinic with a 2-cm, firm, superficially located palpable mass on the lateral thigh adjacent to the knee. The mass has been slowly enlarging over several weeks and is mildly tender with occasional catching during flexion. Imaging (ultrasound) performed in clinic characterizes the lesion as a superficial soft-tissue nodule separate from muscle fascia, suspicious for epidermal inclusion cyst, lipoma, benign nerve sheath tumor, or early soft-tissue sarcoma. After discussion of risks and benefits, the provider performs a diagnostic excisional or incisional biopsy of the superficial soft tissue in the thigh/knee region under local anesthesia. A tissue specimen is submitted to the pathology laboratory for histologic evaluation and ancillary testing as indicated. The typical workflow includes pre-procedure consent, local anesthetic infiltration, tissue removal (partial or complete depending on size and location), hemostasis, and wound closure with sutures or adhesive, then specimen labeling and transport to the surgical pathology service for processing and reporting. Typical site of service is an outpatient clinic procedure room or ambulatory surgery center. Service type: minor surgical procedure (superficial soft tissue biopsy/excision).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure | Use when a distinct E/M visit is performed and documented in addition to the biopsy (Note: is not in the provided modifier list; do not include it if strictly following provided list). |