Summary & Overview

CPT 27365: Excision of Tumor, Femur or Knee

CPT code 27365 denotes surgical excision of a tumor from the femur or knee, a procedure used to treat or diagnose malignancies of the distal femur or peri‑knee region. Nationally, this code is relevant for hospital-based orthopedic oncology services and ambulatory surgical centers that manage primary or metastatic bone tumors. Proper coding supports clinical documentation, utilization monitoring, and payment for complex musculoskeletal oncology procedures.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, expected sites of service, and common payer considerations for claims submission. The publication also highlights billing benchmarks, common modifier usage patterns (listed separately), and policy updates that affect coverage and prior authorization practices for tumor excision procedures.

This resource provides clinicians, coders, and revenue-cycle staff with the operational context needed to align documentation with code intent, understand where services are typically rendered, and anticipate payer review touchpoints. Data not available in the input are noted where applicable in detailed sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare27365CPTorthopedic surgeryoncologytumor excisionfemurkneesurgical procedureambulatory surgeryhospital operating room

Billing Code Overview

CPT code 27365 describes a surgical procedure to remove a tumor from the femur or knee. The procedure is typically performed to treat confirmed malignancies or to obtain tissue for diagnosis when malignancy is suspected.

Service type: Surgical tumor excision (orthopedic oncology)
Typical site of service: Hospital operating room or ambulatory surgical center for orthopedic procedures

Clinical & Coding Specifications

Clinical Context

A 48-year-old patient presents with progressive left distal femur pain, swelling, and occasional night pain. Imaging (radiograph and MRI) demonstrates a lytic lesion in the metaphyseal region of the distal femur suspicious for a primary bone tumor. Core needle biopsy is nondiagnostic or suggests a neoplasm requiring excision. The orthopedic oncology surgeon schedules an open excision of the tumor from the femur/knee region under general anesthesia, performs intraoperative frozen section for margin assessment, and sends tissue for permanent pathology and possible molecular testing. Perioperative workflow includes preoperative oncologic staging, anesthesia evaluation, intraoperative specimen handling, possible reconstruction (bone graft or fixation) depending on defect size, postoperative pain control, and coordination with medical oncology for adjuvant therapy if malignancy is confirmed. Typical site of service is an inpatient or ambulatory surgery center with orthopedic oncology capabilities. Typical service type is a surgical excision of a neoplasm of the femur or knee for diagnostic and therapeutic purposes.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the surgeon’s professional component separate from facility or technical services (rare for this operative service).
`50`

Taxonomy Code	Specialty	Notes
`207X00000X`	Orthopaedic Surgery	Orthopedic oncologists or tumor specialists typically perform femoral/knee tumor excisions.
`2080P0002X`	Surgical Oncology	Surgical oncologists may participate in musculoskeletal tumor resections.
`170000000X`	Diagnostic Radiology	Interventional radiologists perform preoperative biopsy and imaging guidance; radiologists provide diagnostic interpretation.

CPT Code	Description	Relationship to This Procedure
`27075`	Excision of bone tumor, pelvis; marginal, wide, or radical	Pelvic bone tumor excision is an analogous major musculoskeletal tumor resection often performed in the same clinical pathways and may be billed in cases involving pelvic involvement.
`27360`	Incision, drainage, and/or radical resection of tumor, soft tissue of thigh/knee area	Soft tissue tumor resections around the knee/thigh may be performed concurrently or in staged procedures when both bone and soft tissue tumors are present.
`20220`	Removal of lesion or tumor of facial bones; radical resection (example of tumor resection CPT family)	Represents related tumor resection codes in other anatomic sites and is included as context for oncologic surgical coding and technique.
`19307`	Mastectomy, partial or segmental (included as an example of oncologic resections)	Illustrates additional oncologic resection coding commonly encountered in multidisciplinary cancer care pathways.
`76942`	Ultrasound, guidance for needle placement (e.g., biopsy)	Often used for image-guided preoperative needle biopsy to establish diagnosis prior to open excision.

OpenPayer