CPT 27634 Excision Tumor Reimbursement & Policy | OpenPayer

Summary & Overview

CPT 27634: Excision of Deep Soft-Tissue Tumor, Leg/Ankle ≥5 cm

CPT code 27634 identifies the surgical excision of a deep soft-tissue tumor located beneath the fascia or within muscle of the leg or ankle when the lesion measures 5 cm or greater in diameter. This code captures a higher-complexity outpatient or inpatient surgical oncology procedure and is relevant for reimbursement, utilization monitoring, and clinical documentation across US payers. Nationally, accurate use of this code affects claims processing, surgical quality reporting, and cost measurement for care of sizable lower-extremity tumors.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find context on clinical indications for coding this procedure, common sites of service, and how this code maps to surgical oncology workflows. The publication outlines benchmarks for coding prevalence and allowed amounts where available, summarizes recent policy considerations that affect coverage and documentation, and highlights clinical factors—tumor size and depth—that determine assignment of this CPT code. Practical guidance on documentation elements needed to support the code and common billing considerations are described at a national level. Data not available in the input has been noted where applicable.

AetnaBlue Cross Blue ShieldCignaUnitedHealthcareMedicareCPT 27634deep soft-tissue tumorlower extremity surgerysurgical oncologyoperative excisionleg tumor excisionambulatory surgeryhospital operating roomprocedure codingtumor >5cm

Billing Code Overview

CPT code 27634 describes the surgical excision of a tumor located beneath the fascia or within the muscle of the leg or ankle, where the procedure removes the tumor measuring 5 cm or greater in diameter without taking a significant amount of surrounding normal tissue. This is a surgical oncology procedure focused on deep soft-tissue masses of the lower extremity.

Service type: Operative surgical excision, deep soft tissue tumor removal

Typical site of service: Hospital operating room or ambulatory surgical center

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient presents with a progressively enlarging deep soft-tissue mass in the posterior compartment of the lower leg. Imaging with MRI demonstrates a well-circumscribed intramuscular tumor measuring 6.2 cm in greatest diameter, beneath the fascia and within the gastrocnemius muscle, without radiographic involvement of adjacent neurovascular bundles. The orthopedic oncology or surgical oncology team schedules an operative excision under general anesthesia. Preoperative workflow includes history and physical, informed consent discussing risks of bleeding, infection, nerve injury, and potential need for wider resection if malignancy is suspected, preoperative labs, and MRI review. Intraoperative steps include patient positioning, limb prep and drape, an incision over the lesion, dissection through subcutaneous tissue to the fascia, careful entry into the muscle compartment, tumor identification and marginal excision without removal of a significant amount of surrounding normal tissue, hemostasis, possible placement of drains, layered closure, and specimen submission to pathology. Postoperative workflow includes recovery unit monitoring, analgesia, wound care instructions, pathology follow-up for size and margin assessment, and coordinated outpatient follow-up for wound check and oncologic management if indicated. Typical site of service is an ambulatory surgical center or hospital outpatient surgery unit. Service type is operative excision of an intramuscular soft-tissue tumor of the leg/ankle, size ≥5 cm, corresponding to 27634.

Coding Specifications

Modifier	Description	When to Use

CPT 27646: Fibula Tumor Resection with Wide Margins

CPT-27632-SUBCUTANEOUS-TUMOR-EXCISION-3CM-OR-GREATER

CPT 27632: Excision of Subcutaneous Tumor ≥3 cm

CPT-27625-ANKLE-SYNOVECTOMY-OPEN-SURGICAL-PROCEDURE

CPT 27625: Ankle Synovectomy, Open Surgical Procedure

CPT-27626-ANKLE-TENDON-SHEATH-EXCISION-SYNOVECTOMY

CPT 27626: Excision of Ankle Tendon Sheath with Synovectomy

CPT-27635-TIBIAL-FIBULAR-BENIGN-BONE-LESION-EXCISION

CPT 27635: Excision of Benign Bone Lesion, Tibia or Fibula

CPT-27647-HINDFOOT-TUMOR-RESECTION-TALUS-CALCANEUS

CPT 27647: Hindfoot Tumor Resection, Talus or Calcaneus

CPT-27637-TIBIA-FIBULA-BONE-CYST-EXCISION-AUTOGRAFT-REPAIR

CPT 27637: Excision of Tibia or Fibula Bone Cyst with Autograft Repair

CPT-27618-SUBCUTANEOUS-TUMOR-EXCISION-LESS-THAN-3CM

CPT 27618: Excision of Subcutaneous Tumor (<3 cm)

CPT-27630-TENDON-SHEATH-CAPSULE-LESION-EXCISION-LEG-ANKLE

CPT 27630: Excision of Tendon Sheath or Capsule Lesion, Leg/Ankle

CPT-27614-DEEP-SOFT-TISSUE-EXCISION-LEG-ANKLE-LESION-DIAGNOSTIC

CPT 27614: Excision of Deep Soft Tissue Lesion, Leg or Ankle

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Taxonomy Code	Specialty	Notes
207L00000X	Orthopedic Surgery	Orthopedic oncologists or orthopedic surgeons commonly perform excision of intramuscular leg tumors.
2080P0207X	General Surgery	Surgical oncologists or general surgeons with soft-tissue expertise perform resections of leg tumors.
2085R0203X	Surgical Oncology	Surgical oncologists manage tumor resections with oncologic margins and coordination with systemic therapy.
207K00000X	Plastic and Reconstructive Surgery	Plastic surgeons may assist with complex closures or reconstruction following tumor excision.
2084P0800X	Vascular Surgery	Vascular surgeons may be involved when tumors are adjacent to major vessels requiring repair or bypass.

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.	Data not available in the input.	Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`10120`	Incision and removal of foreign body, subcutaneous tissues; simple	May be performed for superficial masses or diagnostic excision distinct from intramuscular tumor resection; not typically used for `27634` but may be billed if a separate superficial lesion is removed.
`27385`	Excision of lesion of hip or thigh, subfascial or intramuscular	Related regional code for intramuscular tumor excision in proximal lower extremity; used for similar procedures at a different anatomical site.
`27387`	Excision of malignant tumor, hip or thigh area, subfascial/intramuscular; with radical resection	Represents a more extensive oncologic resection when wider margins or additional tissue removal is required compared to `27634`.
`20206`	Biopsy, soft tissue lesion of head and neck; excisional	Biopsy codes may be used preoperatively when a diagnostic excision or core biopsy is performed prior to definitive excision like `27634`.
`11042`	Debridement, subcutaneous tissue	May be performed in the postoperative period for wound complications; distinct from tumor excision but relevant to wound management.

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