🩻 CPT 21554 — Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subfascial; 5 Cm Or Greater
Quick Reference
wRVU: 10.85 | Global Period: 090 | Assistant Payable: Yes | Bilateral Indicator: 0 Rule: CPT 21554 reports excision of a subfascial or intramuscular soft-tissue tumor of the neck or anterior thorax measuring 5 cm or greater. The 90-day global period includes usual postoperative care. The Medicare bilateral indicator of 0 means the bilateral-surgery adjustment does not apply; do not append -50 for Medicare payment solely because lesions were excised from both sides.1
📋 Clinical Description
CPT 21554 describes open excision of a soft-tissue tumor from a deep, subfascial location in the neck or anterior thorax when the tumor measures 5 cm or greater. The term subfascial includes a lesion located beneath the fascia and may include an intramuscular tumor. The operative report should identify the exact anatomic region, tumor dimensions, tissue plane, and extent of excision. Accurate selection depends on both depth and size, not pathology alone.2
CPT 21554 differs from 21552, which reports a subcutaneous neck or anterior-thorax tumor measuring 3 cm or greater, and from 21556, which reports a subfascial tumor measuring less than 5 cm. It also differs from 21557 and 21558, which describe radical resection rather than simple excision. Do not select the radical-resection codes merely because the lesion is deep, large, malignant, or adherent to surrounding tissue; the operative documentation must support the more extensive radical procedure.2
This procedure may be performed in the following clinical contexts:
- Deep benign soft-tissue tumor — The surgeon excises a documented benign mass, such as a deep lipoma or other benign connective-tissue neoplasm, from beneath fascia in the neck or anterior thorax. The record must support a 5 cm or greater size.
- Intramuscular tumor — The surgeon removes a tumor arising within or extending into neck or anterior thoracic musculature. Documentation must establish that the lesion is subfascial or intramuscular rather than subcutaneous.
- Neoplasm of uncertain behavior — Excision may be performed when preoperative evaluation identifies a deep soft-tissue neoplasm with uncertain behavior. Final pathology may affect diagnosis coding but does not retroactively change the documented procedural extent.
- Malignant soft-tissue tumor — A malignancy may require excision, but 21554 applies only when the documented work is excision rather than radical resection. Review the operative report for margins, surrounding-structure removal, and the surgeon’s stated procedure.
🔬 Anatomical & Procedural Considerations
| Variant | Mechanism | Key Notes |
|---|---|---|
| Subcutaneous tumor | The lesion is superficial to the fascia and may be located in skin-adjacent subcutaneous tissue. It does not extend into the deep fascial or intramuscular plane. | Do not report 21554 when the lesion is subcutaneous. Select the code based on the documented superficial depth and size, such as 21552 or 21555, when applicable. |
| Subfascial tumor | The lesion lies deep to fascia, may be intermuscular, or may arise within muscle. Excision requires dissection through or beneath the fascial plane. | This is the depth requirement for 21554. The operative note should clearly document deep or subfascial location and support a size of 5 cm or greater. |
| Radical tumor resection | The surgeon performs more extensive removal of a soft-tissue tumor, potentially including surrounding tissue or more complex oncologic work. The procedure exceeds ordinary excision. | Consider 21557 or 21558 only when the operative report supports radical resection. Tumor size alone does not establish that a radical resection was performed. |
Clinical Pearl
For 21554, the tumor must be both subfascial and 5 cm or greater. A pathology diagnosis of malignancy does not by itself establish the CPT code, and a large lesion does not qualify if it is subcutaneous. Documented preoperative or intraoperative size should be retained when pathology measurements differ from the surgeon’s measurement.2
✅ Procedure Includes
- Open incision and dissection required to access the documented subfascial or intramuscular tumor.
- Excision of the tumor from the neck or anterior-thorax soft tissue when it measures 5 cm or greater.
- Routine hemostasis, wound closure, and dressing application integral to the excision.
- Usual postoperative care during the 90-day global period, including routine follow-up related to the excision.
- Submission of excised tissue for pathology when clinically indicated; pathology interpretation is separately reported by the pathologist when performed.
❌ Excludes / Do Not Report Together
| Code | Description | Relationship |
|---|---|---|
| 21552 | Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; 3 cm or greater | Do not report with 21554 for the same tumor. 21552 is selected for a superficial subcutaneous lesion, whereas 21554 requires a subfascial or intramuscular lesion measuring 5 cm or greater. |
| 21555 | Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; less than 3 cm | Do not report with 21554 for the same lesion. The codes represent different depth and size categories. |
| 21556 | Excision, tumor, soft tissue of neck or anterior thorax, subfascial; less than 5 cm | Do not report with 21554 for the same lesion. Select either code using the documented greatest tumor dimension. |
| 21557 | Radical resection of tumor, soft tissue of neck or anterior thorax; less than 5 cm | Do not report in addition to 21554 for the same tumor. Use the radical-resection code only when the documented work supports radical resection rather than routine excision. |
| 21558 | Radical resection of tumor, soft tissue of neck or anterior thorax; 5 cm or greater | Do not report in addition to 21554 for the same tumor. If radical resection is documented for a tumor 5 cm or greater, 21558 replaces rather than supplements 21554. |
Bundling Alert
CPT 21554 has a 90-day global period. Do not separately report routine wound checks, dressing changes, suture removal, or expected postoperative management. Use -24 for an unrelated E/M service during the global period, -58 for a qualifying staged or related procedure, -78 for an unplanned related return to the operating room, and -79 for an unrelated procedure; documentation must support the modifier selected.1
🌳 Code Tree — Surgery: Surgical Procedures On The Neck
CPT 21552-21558 Excision and Radical Resection of Soft-Tissue Tumors of the Neck or Anterior Thorax
│
├── 21552 Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; 3 cm or greater
│
├── 21554-21556 Excision, tumor, soft tissue of neck or anterior thorax
│ ├── 21552 Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; 3 cm or greater (Global: 090)
│ ├── ▶▶ 21554 ◀◀ Excision, tumor, soft tissue of neck or anterior thorax, subfascial (eg, intramuscular); 5 cm or greater ← YOU ARE HERE (Global: 090)
│ ├── 21555 Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; less than 3 cm (Global: 090)
│ └── 21556 Excision, tumor, soft tissue of neck or anterior thorax, subfascial (eg, intramuscular); less than 5 cm (Global: 090)
│
└── 21557-21558 Radical resection of tumor, soft tissue of neck or anterior thorax
├── 21557 Radical resection of tumor, soft tissue of neck or anterior thorax; less than 5 cm
└── 21558 Radical resection of tumor, soft tissue of neck or anterior thorax; 5 cm or greater💰 RVU & Reimbursement Profile
| Component | Value |
|---|---|
| Work RVU | 10.85 |
| Global Period | 090 |
| Bilateral Indicator | 0 |
| Assistant Surgeon | 2 — Assistant at surgery may be paid |
| Co‑Surgeon | 0 — Co-surgery does not apply |
| Team Surgery | 0 — Team surgery does not apply |
| PC/TC Split | 0 — Physician service; PC/TC concept does not apply |
| Modifier -51 Exempt | No |
| Anesthesia | Separately reportable by the qualified anesthesia provider when medically necessary and documented |
Bilateral Billing Rules
The CMS PFS bilateral indicator for 21554 is 0. Medicare does not apply the standard bilateral-procedure adjustment to this code, so do not report -50 solely for excisions on opposite sides. When separately reportable lesions are removed, follow payer-specific multiple-procedure and distinct-service rules, including documentation of separate lesions and distinct operative work.1
🏷️ Modifier Reference
| Modifier | Name | When to Apply |
|---|---|---|
| -24 | Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period | Append to an unrelated E/M service provided during the 90-day global period. The medical record must establish that the E/M service is unrelated to the tumor excision or its routine aftercare. |
| -25 | Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service | Append to the E/M code when a separately identifiable E/M service is performed on the date of excision. Do not append it to 21554, and do not use it for routine preoperative assessment. |
| -51 | Multiple Procedures | Use when multiple separately reportable procedures are performed in the same operative session, subject to payer reporting requirements. Do not use it to separately bill services integral to the excision. |
| -52 | Reduced Services | Use when the planned service is reduced at the physician’s discretion and the operative record identifies the reduced work. It is not appropriate for a procedure discontinued because of an unforeseen threat to patient well-being. |
| -53 | Discontinued Procedure | Use when the procedure is started and discontinued due to extenuating circumstances or a threat to patient well-being. The operative note must state why the procedure was stopped and what work was completed. |
| -54 | Surgical Care Only | Use when the surgeon performs only the operative service and another physician provides postoperative management under a qualifying transfer-of-care arrangement. Payer-specific transfer documentation requirements apply. |
| -55 | Postoperative Management Only | Use when a physician provides only postoperative management after a valid transfer of care. It applies to the postoperative portion of the 90-day global package. |
| -56 | Preoperative Management Only | Use only when a physician provides preoperative management under a qualifying transfer-of-care arrangement. Do not use for routine preoperative work by the operating surgeon. |
| -58 | Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period | Use for a planned or staged related procedure during the global period when modifier requirements are met. An eligible staged procedure begins a new global period. |
| -59 | Distinct Procedural Service | Use only when a separate lesion, separate site, separate encounter, or independent service is clearly documented and no more specific modifier applies. It must not be used to bypass edits for services integral to the excision. |
| -78 | Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period | Use for an unplanned related return to the operating or procedure room during the 90-day global period. The original global period continues. |
| -79 | Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period | Use for an unrelated procedure during the global period when documentation establishes it is unrelated to the original tumor excision. A new global period begins for the unrelated procedure when applicable. |
| -80 | Assistant Surgeon | May be appended by a physician assistant surgeon when an assistant is medically necessary and the assistant-surgery claim requirements are met. The PFS assistant-at-surgery indicator is 2. |
| -81 | Minimum Assistant Surgeon | May be appended by a physician only when minimum assistant-surgeon services are medically necessary and payer requirements are satisfied. Verify payer policy and retain supporting operative documentation. |
| -82 | Assistant Surgeon When Qualified Resident Surgeon Not Available | Use in teaching settings only when a qualified resident surgeon is not available and documentation supports the modifier. Medicare teaching-physician and assistant-at-surgery rules apply. |
| -AS | Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery | Use for qualifying nonphysician practitioner assistant-at-surgery services when allowed by the payer. The assistant’s claim must meet supervision, credentialing, and medical-necessity requirements. |
🩺 Common ICD‑10‑CM Pairings
Primary Diagnosis Group
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| D21.0 | Other benign neoplasm of connective and other soft tissue of head, face and neck | No | Use when the provider documents a benign connective or other soft-tissue neoplasm in the neck or head/face/neck region. Confirm the lesion is in the anatomic area represented by the CPT code. |
| D21.3 | Other benign neoplasm of connective and other soft tissue of thorax | No | Use for a benign connective or soft-tissue tumor involving the thorax when documentation supports anterior thoracic location. Do not use for a lesion limited to skin or breast when a more specific diagnosis applies. |
| D48.19 | Neoplasm of uncertain behavior of connective and other soft tissue | No | Use when the provider documents uncertain behavior and the diagnosis is clinically established. Do not assign from a differential diagnosis or pending pathology alone. |
| C49.0 | Malignant neoplasm of connective and soft tissue of head, face and neck | No | Use for a documented malignant connective or soft-tissue neoplasm of the head, face, or neck. The procedure code still depends on documented depth, size, and operative extent. |
| C49.3 | Malignant neoplasm of connective and soft tissue of thorax | No | Use for a documented malignant connective or soft-tissue neoplasm of the thorax. Confirm the primary site and avoid using this code for secondary malignant involvement unless documentation supports a primary malignancy. |
Secondary Group
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| D49.2 | Neoplasm of unspecified behavior of bone, soft tissue, and skin | No | Use only when the provider documents a neoplasm but does not establish benign, malignant, or uncertain behavior. Query when pathology or provider documentation supports more specific behavior. |
| R22.1 | Localized swelling, mass and lump, neck | No | May be used when the clinician documents a neck mass but no definitive diagnosis has been established. Do not report it in addition to a confirmed tumor diagnosis for the same lesion unless separately supported. |
| R22.2 | Localized swelling, mass and lump, trunk | No | May be appropriate for an anterior-thorax mass when no definitive diagnosis has been established. Use a confirmed neoplasm code when the provider establishes the tumor diagnosis. |
Etiology / Complication
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| D17.0 | Benign lipomatous neoplasm of skin and subcutaneous tissue of head, face and neck | No | This code may support excision of a benign lipomatous lesion when provider documentation supports the diagnosis. Verify depth because a subcutaneous lesion does not meet the depth requirement for 21554. |
| D17.1 | Benign lipomatous neoplasm of skin and subcutaneous tissue of trunk | No | This code may support an anterior-thorax lipomatous lesion when documented. Confirm whether the lesion is subcutaneous versus deep before selecting the procedure code. |
Coding Specificity Reminder
Code the confirmed behavior, histology, and most specific anatomic site documented by the provider. A diagnosis based only on pathology should be reconciled with the surgeon’s final diagnostic statement when applicable. Do not assign a malignant, benign, or uncertain-behavior diagnosis merely because tissue was excised or sent for pathology.3
🏥 MS‑DRG Considerations
CPT [[21554]] does not determine an MS-DRG because inpatient MS-DRG assignment is based on the complete ICD-10-CM diagnosis set, ICD-10-PCS procedure code(s), discharge disposition, and applicable grouping logic. For an inpatient excision, ICD-10-PCS code selection depends on the deepest tissue removed, the specific body part, whether the procedure was excision or resection, approach, and whether tissue was removed for diagnostic purposes. No nationwide NCD specifically governing CPT 21554 was identified, and no universally applicable LCD was identified in the CMS Medicare Coverage Database review. The CMS PFS Lookup tool supplies payment data and policy indicators, including the 90-day global period and surgical-assistant indicator, but it does not establish medical-necessity coverage; verify any MAC-specific LCD or billing-and-coding article for the applicable jurisdiction before billing.145
🔧 ICD‑10‑PCS Equivalents
| PCS Code | Full Description | Modality |
|---|---|---|
| 0KB20ZZ | Excision of Right Neck Muscle, Open Approach | Open excision |
| 0KB30ZZ | Excision of Left Neck Muscle, Open Approach | Open excision |
| 0KBH0ZZ | Excision of Right Thorax Muscle, Open Approach | Open excision |
| 0KBJ0ZZ | Excision of Left Thorax Muscle, Open Approach | Open excision |
The CPT-to-PCS relationship is not one-to-one. These examples are appropriate when the lesion is excised from the documented neck or thorax muscle and the operative record supports an open excision; a lesion limited to subcutaneous tissue and fascia requires a different PCS body-system table. Final inpatient PCS reporting depends on the operative note, including the deepest layer removed and whether the objective was excision of part of a body part or resection of all of a body part.5
PCS Character Analysis
| Position | Character | Value | Definition |
|---|---|---|---|
| 1 | Section | 0 | Medical and Surgical. This section is used for procedures that involve operative treatment of body structures. |
| 2 | Body System | K | Muscles. This body-system value applies when the excised tumor involves muscle. |
| 3 | Root Operation | B | Excision. Excision is defined as cutting out or off, without replacement, a portion of a body part. |
| 4 | Body Part | 2, 3, H, or J | 2 identifies right neck muscle, 3 identifies left neck muscle, H identifies right thorax muscle, and J identifies left thorax muscle. Select the documented body part and laterality. |
| 5 | Approach | 0 | Open. Open approach means cutting through skin or mucous membrane and other layers necessary to expose the site of the procedure. |
| 6 | Device | Z | No device. Use another device value only when a device remains in place at the end of the procedure and the PCS table directs it. |
| 7 | Qualifier | Z | No qualifier. Use diagnostic qualifier X only when the procedure is performed for diagnostic purposes as defined by PCS. |
Root Operation Comparison
- Excision applies when the surgeon cuts out or off a portion of the muscle or other body part, such as a discrete tumor. This is commonly the PCS root operation for removal of a localized soft-tissue mass.
- Resection applies when the surgeon cuts out or off all of a body part. Do not assign resection merely because the operative report uses the word “resection” colloquially.
- Excision of subcutaneous tissue and fascia may be more appropriate than muscle excision when the deepest tissue removed is fascia or subcutaneous tissue rather than muscle. Use the documented deepest layer to choose the PCS body system.
📝 Coding Examples
Example 1
Clinical Scenario: A surgeon excises a 6.2 cm benign intramuscular mass from the right sternocleidomastoid region. The operative report documents dissection through fascia, removal of the mass from muscle, and layered closure. Final pathology confirms a benign connective-tissue neoplasm of the neck.
| Field | Code | Rationale |
|---|---|---|
| CPT | 21554 | The mass is subfascial or intramuscular, located in the neck, and measures 5 cm or greater. |
| PDx | D21.0 | The final diagnosis identifies a benign connective or other soft-tissue neoplasm of the head, face, or neck. |
Note
The operative note must document the 6.2 cm size and deep intramuscular or subfascial location. Do not append bilateral modifiers because the PFS bilateral indicator is 0.
Example 2
Clinical Scenario: A surgeon removes a 7 cm deep soft-tissue tumor from the anterior thoracic musculature. The tumor is dissected from the underlying muscle without removal of adjacent organs or an extensive radical-resection field. Pathology remains pending at claim submission, and the physician documents a neoplasm of uncertain behavior.
| Field | Code | Rationale |
|---|---|---|
| CPT | 21554 | The tumor is subfascial, located in the anterior thorax, and measures 5 cm or greater. The record supports excision rather than radical resection. |
| PDx | D48.19 | The provider documents a connective or other soft-tissue neoplasm of uncertain behavior. |
Warning
Do not substitute 21558 merely because the tumor is 7 cm or because malignancy is suspected. Radical-resection documentation is required for the radical-resection code.
Example 3
Clinical Scenario: During the 90-day global period after a prior neck tumor excision, the patient returns urgently with a postoperative hematoma requiring an unplanned related return to the operating room. The original surgeon evacuates the hematoma and performs related wound exploration. The service is medically necessary and documented as an unplanned related postoperative return.
| Field | Code | Rationale |
|---|---|---|
| CPT | 21554--78 | -78 may be appropriate only if the repeat reported procedure is supported as an unplanned related return to the operating or procedure room. |
| PDx | D21.0 | The original benign neck soft-tissue tumor remains relevant when it supports the underlying operative history. |
Global period reminder
⚠️ Common Coding Pitfalls
- Pitfall 1: Reporting 21554 for a subcutaneous lesion. The code requires a subfascial or intramuscular tumor, so superficial depth supports a different code.
- Pitfall 2: Failing to document the tumor’s greatest dimension. The 5 cm threshold is essential for distinguishing 21554 from 21556.
- Pitfall 3: Using pathology size without reconciling it to the surgeon’s documented operative size. Preserve documentation supporting the selected size category and query when conflicting measurements materially affect coding.
- Pitfall 4: Reporting a radical-resection code solely because a tumor is malignant or large. The documented operative extent, not tumor behavior or size alone, determines whether radical resection was performed.
- Pitfall 5: Appending -50 because separate tumors are removed from opposite sides. The PFS bilateral indicator is 0, so the Medicare bilateral adjustment does not apply to this code.
- Pitfall 6: Billing routine postoperative care separately during the 90-day global period. Routine follow-up, wound care, and expected recovery management are included unless a valid modifier supports a distinct service.
📎 Sources
1 Centers for Medicare & Medicaid Services. Medicare Physician Fee Schedule Look-Up Tool and 2026 PFS Relative Value Files, 2026. CPT 21554 payment-policy indicators: work RVU 10.85, global period 090, bilateral-surgery indicator 0, PC/TC indicator 0, assistant-at-surgery indicator 2, co-surgeon indicator 0, and team-surgery indicator 0.
2 American Medical Association. Current Procedural Terminology, CPT 2026 Professional Edition. CPT family 21552, 21554, 21555, 21556, 21557, and 21558.
3 Centers for Medicare & Medicaid Services. ICD-10-CM Official Guidelines for Coding and Reporting and FY 2026 ICD-10-CM code set, 2026.
4 Centers for Medicare & Medicaid Services. Medicare Coverage Database Search, reviewed August 10, 2026. No nationwide NCD or universally applicable LCD specifically governing CPT 21554 was identified; verify local MAC LCD and billing-and-coding articles.
5 Centers for Medicare & Medicaid Services. FY 2026 ICD-10-PCS Official Guidelines for Coding and Reporting and ICD-10-PCS Tables 0JB and 0KB, 2026.
Sources listed above correspond to superscript citations throughout this note. Verify all Medicare payment figures against your current CMS PFS Lookup tool and applicable MAC LCD prior to claim submission. Please use the latest AAPC/AHIMA Coding Books to verify each code within this note.