CPT 41145 Total Glossectomy Reimbursement | OpenPayer

Summary & Overview

CPT 41145: Total Glossectomy with Unilateral Neck Dissection

CPT code 41145 represents a major oncologic head and neck surgery — total glossectomy with possible tracheostomy and unilateral neck dissection. Nationally, the code identifies high-acuity surgical management of advanced or extensive tongue cancers where airway protection and removal of regional lymphatic tissue are clinically indicated. Its use signals complex inpatient resource needs, including operating room time, intensive postoperative care, and potential airway management services.

Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and the operational implications for billing and claims processing. The publication covers expected components of the service line, common modifiers encountered in practice, and related coding considerations where available. It also outlines benchmarking and policy topics relevant to national payers, such as coverage frameworks for high-acuity surgical oncology procedures and postoperative airway management. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 41145total glossectomyhead and neck surgerysurgical oncologyinpatient servicetracheostomyneck dissectionoperative procedurebilling and codinghigh-acuity care

Billing Code Overview

CPT code 41145 describes a surgical procedure in which the entire tongue (glossectomy with total removal) is removed and may include a tracheostomy to establish an artificial airway for postoperative breathing support. The code also encompasses removal of lymph nodes and adjacent tissues from one side of the neck (unilateral neck dissection) when performed as part of the same operative session. This procedure is most often performed for treatment of head and neck cancer.

Service Type: Major head and neck surgical oncology procedure

Typical Site of Service: Inpatient hospital operating room with postoperative inpatient recovery

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Clinical & Coding Specifications

Clinical Context

A 62-year-old male with a long history of tobacco and alcohol use presents with a bulky, invasive squamous cell carcinoma of the anterior two-thirds of the tongue confirmed by biopsy. Imaging demonstrates primary tumor with ipsilateral cervical lymph node metastases but no distant spread. The multidisciplinary head and neck surgical team schedules a radical surgical resection consisting of total glossectomy with unilateral neck dissection and planned tracheostomy for postoperative airway management. The patient is admitted the morning of surgery to an operating room equipped for major head and neck oncologic procedures. General endotracheal anesthesia is induced; the surgical team performs complete removal of the tongue, resects involved ipsilateral cervical lymph nodes, and creates a temporary tracheostomy to secure the airway during immediate recovery. Intraoperative pathology may guide margin assessment and additional tissue excision. Postoperatively the patient is transferred to an intensive care or step-down unit for airway monitoring, pain control, enteral nutrition planning, and coordination with medical oncology and radiation oncology for adjuvant therapy planning if indicated. Documentation in the operative note should describe the extent of tongue removal, levels of neck dissection, whether a tracheostomy was performed, intraoperative findings, reconstruction if any, estimated blood loss, and disposition.

Coding Specifications

Modifier	Description	When to Use
`11`	Normal or standard procedure performed

CPT 41116: Excision of Lesion, Floor of Mouth

CPT-41130-PARTIAL-GLOSSECTOMY-LATERAL-TONGUE-RESECTION

CPT 41130: Partial Glossectomy, Lateral Half of Tongue

CPT-41113-EXCISION-LESION-POSTERIOR-TONGUE

CPT 41113: Excision of Lesion, Posterior One-Third of Tongue

CPT-41153-GLOSSECTOMY-FLOOR-OF-MOUTH-SUPRAHYOID-NECK-DISSECTION

CPT 41153: Glossectomy with Floor of Mouth Resection and Suprahyoid Neck Dissection

CPT-41150-PARTIAL-OR-TOTAL-GLOSSECTOMY-WITH-MANDIBULECTOMY-FLOOR-MOUTH

CPT 41150: Glossectomy with Mandible and Floor-of-Mouth Resection

CPT-41140-TOTAL-GLOSSECTOMY-WITH-TRACHEOSTOMY

CPT 41140: Total Glossectomy with Tracheostomy

CPT-41115-LINGUAL-FRENUM-EXCISION-BASE-OF-TONGUE

CPT 41115: Excision of Lingual Frenum at Base of Tongue

CPT-41100-TONGUE-EXCISIONAL-BIOPSY-ANTERIOR-TWO-THIRDS

CPT 41100: Excisional Tongue Biopsy, Anterior Two Thirds

CPT-41105-POSTERIOR-TONGUE-BIOPSY-EXCISION

CPT 41105: Posterior Tongue Biopsy, Excisional

CPT-41120-PARTIAL-GLOSSECTOMY-LESS-THAN-HALF-TONGUE

CPT 41120: Partial Glossectomy, Less Than Half of Tongue

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Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C02.9`	Malignant neoplasm of tongue, unspecified	Primary diagnosis indicating malignancy of the tongue often treated with total glossectomy for advanced disease.
`C02.0`	Malignant neoplasm of dorsal surface of tongue	Specific primary site that may require wide resection including total glossectomy when extensive.
`C02.1`	Malignant neoplasm of border of tongue	Lateral tongue cancers that can invade extensively and require radical resection and neck dissection.
`C02.2`	Malignant neoplasm of ventral surface of tongue	Ventral lesions with local invasion that may necessitate total removal.
`C02.3`	Malignant neoplasm of anterior two-thirds of tongue	Common location for squamous cell carcinoma treated with glossectomy for control of primary tumor.
`C09.0`	Malignant neoplasm of tonsillar pillars	Nearby or synchronous upper aerodigestive cancers that influence surgical planning and neck dissection.
`C07`	Malignant neoplasm of parotid gland	Regional head and neck malignancies that may be addressed in comprehensive oncologic surgery planning.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`42410`	Glossectomy, partial; hemiglossectomy	Performed for smaller tumors or as initial resection before total glossectomy when tumor extent is limited.
`41140`	Radical glossectomy, limited (subtotal)	Similar major resection codes that may be used when extent differs; helps define surgical extent in operative planning.
`38745`	Selective neck dissection of levels I-III	Often performed in conjunction with glossectomy to remove ipsilateral nodal disease; maps to neck dissection component when unilateral.
`42830`	Tracheostomy, planned (temporary)	Performed to secure airway postoperatively; may be performed at the same operative session as the glossectomy.
`15734`	Muscle, myocutaneous or fasciocutaneous flap with microvascular anastomosis	Common reconstruction technique after total glossectomy to restore bulk and facilitate swallowing/speech; used when free flap reconstruction is performed.

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