CPT 41155 Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

CPT 41155: Radical Tongue and Mandible Resection with Unilateral Neck Dissection

CPT code 41155 represents a major head and neck oncologic resection that removes all or part of the tongue, part of the mandible, the floor of mouth tissues, and includes unilateral neck dissection for lymphadenectomy. Nationally, this code denotes high-complexity surgical care typically performed for oral cavity cancers and is associated with hospital-based operative and inpatient services. Payers commonly engaged in coverage and reimbursement decisions for this procedure include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will learn the clinical scope captured by CPT code 41155, the typical site and setting of service, and the payer landscape relevant to reimbursement and coverage discussions. The publication provides benchmarks and policy context for hospital and surgical service lines, highlights clinical considerations tied to major head and neck oncologic surgery, and flags areas where supplemental documentation and coding specificity can affect payment. Data not available in the input are noted where applicable. This overview is intended for a national audience including coding professionals, hospital administrators, and policy analysts.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare41155CPThead-and-neck-surgeryglossectomymandibulectomyneck-dissectiononcologic-surgeryhospital-surgery

Billing Code Overview

CPT code 41155 describes a radical surgical procedure that removes all or part of the tongue (glossectomy), includes resection of part of the mandible (jaw bone) and the tissue of the floor of the mouth, and incorporates removal of lymph nodes and other tissues from one side of the neck. This procedure is most often used to treat oral cavity cancer.

Service type: Major head and neck oncologic resection with unilateral neck dissection
Typical site of service: Hospital operating room, often with inpatient postoperative admission

Clinical & Coding Specifications

Clinical Context

A 62-year-old male with a history of heavy tobacco and alcohol use presents with a progressively enlarging, ulcerated mass of the lateral oral tongue with induration of the adjacent floor of mouth and clinical fixation to the mandible. Imaging (contrast-enhanced CT and MRI) demonstrates a primary tumor involving the anterior two-thirds of the tongue with cortical erosion of the ipsilateral mandibular body and radiographic suspicious ipsilateral level I–III lymphadenopathy. Biopsy confirms squamous cell carcinoma of the tongue. The multidisciplinary head and neck tumor board recommends primary surgical management with hemiglossectomy, ipsilateral segmental mandibulectomy (through both intraoral and extraoral approaches), and unilateral selective neck dissection. Preoperative workflow includes anesthesia evaluation, dental/oral surgery consult for mandibular reconstruction planning, staging imaging, and consent for possible tracheostomy and free flap reconstruction. Intraoperatively, the surgeon performs resection of the involved portion of the tongue and mandible, wide local excision of the floor of mouth tissues, and removal of ipsilateral cervical lymph nodes. Postoperative care includes airway monitoring (possible short-term tracheostomy), flap monitoring if reconstruction performed, pathology-directed adjuvant therapy planning, and coordination with medical and radiation oncology for adjuvant treatment as indicated by margins and nodal status.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services

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

CPT 41120: Partial Glossectomy, Less Than Half of Tongue

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

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

CPT-41113-EXCISION-LESION-POSTERIOR-TONGUE

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

CPT-41105-POSTERIOR-TONGUE-BIOPSY-EXCISION

CPT 41105: Posterior Tongue Biopsy, Excisional

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

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

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

CPT 41100: Excisional Tongue Biopsy, Anterior Two Thirds

CPT-41112-TONGUE-LESION-EXCISION-ANTERIOR-TWO-THIRDS

CPT 41112: Excision of Lesion, Anterior Two-Thirds of Tongue

CPT-41108-FLOOR-OF-MOUTH-BIOPSY-EXCISION

CPT 41108: Biopsy, Incision and Excision of Floor of Mouth Tissue

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Taxonomy Code	Specialty	Notes
`207R00000X`	Otolaryngology (ENT)	Primary specialty performing complex oral cavity and neck resections.
`208600000X`	Oral and Maxillofacial Surgery	Frequently involved for mandible resection and reconstruction.
`207X00000X`	Plastic and Reconstructive Surgery	Involved when free flap or complex reconstruction is required.
`2083P0800X`	General Surgery (Surgical Oncology)	May participate in advanced oncologic resections and neck dissections.
`363L00000X`	Hematology/Oncology (Medical Oncology)	Not a surgical provider taxonomy but involved in pre/postoperative multidisciplinary care and adjuvant planning.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C02.3`	Malignant neoplasm of lateral border of tongue	Common primary site for tumors requiring hemiglossectomy and partial mandibulectomy.
`C01`	Malignant neoplasm of base of tongue	Tumors of the tongue base may require extensive resection and neck dissection.
`C04.0`	Malignant neoplasm of floor of mouth, anterior portion	Involvement of floor of mouth tissues is part of the described procedure.
`C41.2`	Malignant neoplasm of mandible	Primary or extension into mandible necessitates segmental mandibulectomy.
`C77.0`	Secondary and unspecified malignant neoplasm of lymph nodes of head, face and neck	Indicates regional nodal metastasis prompting neck dissection.
`Z85.81`	Personal history of malignant neoplasm of head and neck	Relevant for surveillance and possible re-resection or recurrence management.
`C02.4`	Malignant neoplasm of ventral surface of tongue	Another common tongue subsite requiring similar operative management.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`31500`	Intubation, endotracheal, emergency procedure or for prolonged airway management	May be performed preoperatively or postoperatively for airway protection; relevant if tracheostomy considered.
`31610`	Tracheostomy, planned (separate procedure)	Performed when prolonged airway control is anticipated or postoperative airway compromise is likely.
`88309`	Surgical pathology, gross and microscopic examination with immunohistochemistry (per block)	Pathology services for margin assessment and tumor characterization; reported by pathology lab.
`21130`	Reconstruction of mandibular continuity defect, partial; without free tissue transfer	Used when reconstruction of mandible is required without free flap.
`21141`	Reconstruction mandibular continuity with free vascularized bone graft (e.g., fibula free flap)	Used when bony reconstruction requires free tissue transfer following segmental mandibulectomy.
`38745`	Neck dissection, unilateral, radical or modified (selective levels I–III)	Often performed concurrently as the lymphadenectomy component of the procedure.

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