CPT 43611 Gastric Tumor Excision Reimbursement | OpenPayer

Summary & Overview

CPT 43611: Excision of Cancerous Stomach Tumor

Headline: CPT code 43611 covers surgical excision of a cancerous stomach tumor, a key procedure in gastric cancer care.

Lead: CPT code 43611 denotes the surgical removal of a malignant gastric tumor to prevent metastasis or to debulk the tumor ahead of radiation or chemotherapy. This operative intervention is central to multidisciplinary cancer management and impacts surgical services utilization and payer reimbursement patterns nationally.

Why it matters: Surgical excision for gastric malignancy directly affects patient prognosis, care pathways, and resource allocation across inpatient and outpatient surgical settings. As definitive or cytoreductive therapy, the procedure influences subsequent oncologic treatments and hospital surgical volumes.

Key payers covered: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare are the primary payers referenced for national coverage and reimbursement considerations.

What readers will learn: The publication provides clinical context for CPT code 43611, outlines typical sites of service, and summarizes the code’s relevance to surgical oncology workflows. Readers will find benchmarks and policy-relevant observations where data is available, along with practical coding context for billing teams and clinical administrators. Data not available in the input will be identified as such.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 43611gastric surgerysurgical oncologytumor excisionstomach canceroperative procedurehospital servicesoncology care

Billing Code Overview

CPT code 43611 describes the surgical excision of a cancerous tumor of the stomach performed to prevent metastasis or to reduce tumor bulk in preparation for radiation or chemotherapy. This service is a surgical oncology procedure focused on tumor removal within the stomach.

Service type: Surgical excision of gastric tumor
Typical site of service: Inpatient or outpatient surgical suite at a hospital or specialized surgical center

Clinical & Coding Specifications

Clinical Context

A 64-year-old patient with biopsy-proven gastric adenocarcinoma presents with a bulky, localized gastric tumor causing symptoms of early satiety and weight loss. Imaging (CT abdomen/pelvis with contrast) demonstrates a primary gastric mass without distant metastasis but with concern for regional lymph node involvement. The multidisciplinary tumor board recommends excisional resection of the gastric tumor to reduce tumor burden prior to neoadjuvant chemotherapy and radiation or to attempt curative resection depending on intraoperative findings. The patient is evaluated preoperatively by surgical oncology, medical oncology, and anesthesia; informed consent is obtained. On the day of service the patient undergoes general endotracheal anesthesia, operative excision of the gastric tumor (partial gastrectomy or tumor excision depending on location and extent), intraoperative frozen section as indicated, hemostasis, and placement of drains as needed. Postoperative inpatient recovery includes pain control, early ambulation, diet advancement per enhanced recovery after surgery (ERAS) protocol, pathology review of the specimen for margin status, and coordination of adjuvant or neoadjuvant therapy with oncology based on final staging.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the procedure requires substantially greater work than normal due to severity, such as extensive tumor resection with complex reconstruction.

CPT 43622: Total Gastrectomy with Esophagoduodenal Pouch Reconstruction

CPT-43605-OPEN-BIOPSY-EXCISION-GASTRIC-LESION

CPT 43605: Open Biopsy and Excision of Gastric Lesion

CPT-43634-PARTIAL-GASTRECTOMY-WITH-INTESTINAL-POUCH-RECONSTRUCTION

CPT 43634: Partial Gastrectomy With Intestinal Pouch Reconstruction

CPT-43633-PARTIAL-GASTRECTOMY-STOMACH-RESECTION-RECONSTRUCTION

CPT 43633: Partial Gastrectomy with Small Bowel Anastomosis

CPT-43635-GASTRIC-RESECTION-WITH-VAGOTOMY

CPT 43635: Gastric Resection with Vagotomy

CPT-43640-VAGOTOMY-AND-PYLORIC-REPAIR-PYLOROPLASTY

CPT 43640: Vagotomy with Pyloric Repair (Pyloroplasty)

CPT-43631-PARTIAL-GASTRECTOMY-GASTRODUODENOSTOMY

CPT 43631: Partial Gastrectomy with Gastroduodenostomy

CPT-43632-PARTIAL-GASTRECTOMY-WITH-GASTROJEJUNOSTOMY

CPT 43632: Partial Gastrectomy with Gastrojejunostomy Reconstruction

CPT-43610-GASTRIC-EXPLORATION-LESION-EXCISION

CPT 43610: Surgical Exploration of Stomach with Lesion Excision

CPT-43621-TOTAL-GASTRECTOMY-SMALL-BOWEL-ANASTOMOSIS

CPT 43621: Total Gastrectomy with Small-Bowel Anastomosis

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Taxonomy Code	Specialty	Notes
207X00000X	General Surgery	Surgeons who perform gastric tumor excisions and partial gastrectomy procedures.
2080P0207X	Surgical Oncology	Specialists in oncologic resections including gastric cancer surgery.
207L00000X	Thoracic Surgery	Involved when tumor location or combined thoracoabdominal approach is necessary.
2084P0800X	Gastroenterology	Participates in diagnostic endoscopy, biopsy, and perioperative endoscopic procedures.
208100000X	Medical Oncology	Manages neoadjuvant and adjuvant systemic therapy coordination.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C16.0`	Malignant neoplasm of cardia	Tumors at the gastroesophageal junction may require excision to prevent spread and enable multimodal therapy.
`C16.1`	Malignant neoplasm of fundus of stomach	Fundal gastric cancers are indications for tumor excision or partial gastrectomy.
`C16.2`	Malignant neoplasm of body of stomach	Common primary site for gastric adenocarcinoma treated with excision.
`C16.3`	Malignant neoplasm of antrum, pyloric	Distal gastric tumors often require resection and reconstruction.
`C16.4`	Malignant neoplasm of lesser curvature of stomach	Tumors on the lesser curvature can be excised with partial gastrectomy depending on size.
`C16.5`	Malignant neoplasm of greater curvature of stomach	Tumors here may need surgical excision to reduce bulk and enable adjuvant therapy.
`C16.9`	Malignant neoplasm of stomach, unspecified	Used when the gastric tumor location is not specified but excision is performed.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`43239`	Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple	Preoperative diagnostic endoscopy with biopsy to confirm gastric malignancy and localize lesion prior to excision.
`49000`	Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) (separate procedure)	Used when an open abdominal exploration is required to locate or assess tumor and decide extent of resection.
`44120`	Enterectomy, resection of small intestine; single resection and anastomosis	Performed if tumor invasion requires concurrent small bowel resection during gastric tumor excision.
`43842`	Gastric restrictive procedure, partial gastrectomy, proximal gastrectomy; with reconstruction	Commonly billed for partial gastrectomy procedures that remove a gastric tumor with reconstruction.
`76942`	Ultrasonic guidance for needle placement (e.g., biopsy)	Used for intraoperative or preoperative image-guided biopsies of suspicious lesions or lymph nodes.
`88305`	Surgical pathology, gross and microscopic examination	Pathology evaluation of the excised tumor specimen to determine diagnosis, margins, and staging.

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