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CPT 44950: Appendectomy for Inflamed Appendix

CPT code 44950 represents an appendectomy for removal of an inflamed appendix and is a common general surgical procedure performed to relieve pain and prevent infection or rupture. Nationally, appendectomy coding matters because it affects hospital surgical throughput, inpatient and outpatient surgical reimbursement, and quality reporting tied to acute surgical care pathways. The code is relevant across commercial payers and government programs.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, common diagnosis mappings such as acute appendicitis and appendicular abscess, and how 44950 relates to nearby procedure codes for ruptured appendix, laparoscopic approaches, and concurrent abdominal operations.

The publication outlines expected sites of service and service type, lists common related procedure codes, and summarizes typical coding considerations used by clinicians and billing staff. It also presents payer coverage alignment and benchmarking context for the listed payers where available. Data not available in the input is noted where applicable. This resource is designed for clinicians, coding professionals, and policy analysts who need a clear, national-level reference for CPT code 44950 and its clinical and billing context.

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Billing Code Overview

CPT code 44950 describes the surgical removal of an inflamed appendix (appendectomy) performed to relieve pain and prevent infection or rupture. The procedure involves excision of the appendix, a saclike structure located in the right lower quadrant at the junction of the small and large intestines.

Service Type: Surgical procedure — appendectomy

Typical Site of Service: Operating room or surgical suite, inpatient or outpatient hospital setting

National Reimbursement Benchmarks

Medicare’s mean rate of $610.7 sits well below BUCA’s average commercial mean of $2,178, indicating a substantial gap between public and this commercial benchmark for CPT 44950. The difference of $1,567.3 highlights how commercial reimbursement can materially exceed Medicare, with BUCA’s mean roughly 3.6 times Medicare’s mean on a national basis.

Dispersion varies notably across payers. Blue Cross Blue Shield’s interquartile range (P75–P25) is $2,512.5, the widest, signaling high variability in commercial payments; BUCA’s IQR is $1,721.9, also broad. UnitedHealth Group has an IQR of $715.7 and Cigna’s IQR is $676.0, indicating moderate spread. Aetna shows the tightest IQR at $599.2, reflecting relatively concentrated contracted rates among those listed.

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CPT 44950: Appendectomy for Inflamed Appendix

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Get alerted when payer policies referencing 44950 are released or updated.

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Billing Code Overview

Service Type: Surgical procedure — appendectomy

Typical Site of Service: Operating room or surgical suite, inpatient or outpatient hospital setting

National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

A 28-year-old otherwise healthy patient presents to the emergency department with 24 hours of progressive right lower quadrant abdominal pain, anorexia, fever (38.2°C), and mild leukocytosis. Clinical examination reveals tenderness and guarding in the right lower quadrant; imaging (abdominal ultrasound or CT) demonstrates an enlarged, inflamed appendix without clear perforation. The surgeon obtains informed consent and schedules an urgent open appendectomy. In the operating room under general anesthesia, the provider performs a standard open removal of the appendix via a right lower quadrant (McBurney) incision to relieve pain and prevent progression to abscess or rupture. Intraoperative findings are documented (e.g., inflamed versus gangrenous appendix, presence or absence of perforation or abscess). Postoperative workflow includes recovery room monitoring, pain control, antibiotics if indicated, and discharge planning with wound care instructions and follow-up.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when additional work beyond usual is documented (e.g., extensive adhesiolysis or severe inflammation significantly increasing operative work).
`50`	Bilateral procedure	Not commonly applicable to appendectomy but included when bilateral synchronous procedures are reported on the same claim if relevant.
`51`	Multiple procedures	When the appendectomy is performed with one or more additional distinct procedures during the same operative session.
`52`	Reduced services	Use if the procedure was started but not completed as billed (e.g., aborted due to instability).
`53`	Discontinued procedure	When the procedure is terminated after initiation due to extenuating circumstances.
`62`	Two surgeons	If two surgeons with different specialties actively perform distinct portions of the appendectomy.
`63`	Procedure performed on infants less than 4 kg	Applicable when the patient meets the weight criteria and documentation supports it.
`66`	Surgical team approach	When a surgical team performs the procedure and payment policies allow team reporting.
`78`	Unplanned return to the operating/ procedure room by the same physician following initial procedure for a related procedure during the postoperative period	Use for reoperation during the global period for a complication of the initial appendectomy.
`79`	Unrelated procedure or service by the same physician during the postoperative period	When a subsequent procedure during the global period is unrelated to the appendectomy.
`80`	Assistant surgeon	When an assistant surgeon provides assistance throughout the procedure and reporting is allowed.
`81`	Minimum assistant surgeon	When a minimal assistant surgeon role is documented and payer accepts modifier usage.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an advanced practice clinician acts as an assistant and the payer accepts modifier `AS` for payment.
`TC`	Technical component	Rare for a surgical procedure like appendectomy, but used when only the technical component of a bundled service is billed separately (e.g., unusual contractual arrangements).

Taxonomy Code	Specialty	Notes
`208600000X`	Surgery Physician	General surgeons commonly perform open appendectomy and are primary billers for `44950`.
`208800000X`	Colon & Rectal Surgery Physician	Colorectal surgeons may perform appendectomy when involved in complex lower abdominal pathology.
`208D00000X`	General Practice Physician	In some settings, general practitioners with surgical privileges may perform appendectomy; documentation must support privileges.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K35.80`	Acute appendicitis without perforation or gangrene	Typical indication for an urgent open appendectomy coded by `44950` when appendix is inflamed but not perforated.
`K35.2`	Acute appendicitis with generalized peritonitis	Indicates a more severe presentation; may require `44960` if rupture with generalized peritonitis is present, but still relevant to operative decision-making.
`K36`	Other appendicitis	Includes atypical or specified forms of appendicitis that may necessitate appendectomy.
`K37`	Unspecified appendicitis	Used when the record documents appendicitis but lacks specificity; supports the need for appendectomy when clinical documentation matches.
`K38.1`	Appendicular abscess	Represents localized abscess formation; may alter operative approach (drainage, more extensive exploration) and postoperative care.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`44955`	Appendectomy; when done for indicated purpose at time of other major procedure (not as separate procedure)	Used when an appendectomy is performed incident to another major abdominal procedure and not reported separately as the primary service.
`44960`	Appendectomy; for ruptured appendix with abscess or generalized peritonitis	Billed instead of `44950` when intraoperative findings include rupture with abscess or generalized peritonitis requiring more extensive management.
`49000`	Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) (separate procedure)	Performed when a full exploratory laparotomy is required for diagnosis or management; appendectomy may be performed during the same laparotomy.
`44180`	Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure)	Billed separately when significant adhesiolysis is required during an appendectomy and the service is distinct and documented.
`44120`	Enterectomy, resection of small intestine; single resection and anastomosis	Used when appendiceal disease necessitates resection of adjacent small bowel (e.g., severe inflammation, necrosis) in addition to appendectomy.

CPT 44955: Appendectomy Performed Incident to Another Major Procedure

CPT-44960-APPENDECTOMY-RUPTURED-APPENDIX-ABSCESS-PERITONITIS

CPT 44960: Appendectomy for Ruptured Appendix with Abscess or Peritonitis

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when additional work beyond usual is documented (e.g., extensive adhesiolysis or severe inflammation significantly increasing operative work).
`50`	Bilateral procedure	Not commonly applicable to appendectomy but included when bilateral synchronous procedures are reported on the same claim if relevant.
`51`	Multiple procedures	When the appendectomy is performed with one or more additional distinct procedures during the same operative session.
`52`	Reduced services	Use if the procedure was started but not completed as billed (e.g., aborted due to instability).
`53`	Discontinued procedure	When the procedure is terminated after initiation due to extenuating circumstances.
`62`	Two surgeons	If two surgeons with different specialties actively perform distinct portions of the appendectomy.
`63`	Procedure performed on infants less than 4 kg	Applicable when the patient meets the weight criteria and documentation supports it.
`66`	Surgical team approach	When a surgical team performs the procedure and payment policies allow team reporting.
`78`	Unplanned return to the operating/ procedure room by the same physician following initial procedure for a related procedure during the postoperative period	Use for reoperation during the global period for a complication of the initial appendectomy.
`79`	Unrelated procedure or service by the same physician during the postoperative period	When a subsequent procedure during the global period is unrelated to the appendectomy.
`80`	Assistant surgeon	When an assistant surgeon provides assistance throughout the procedure and reporting is allowed.
`81`	Minimum assistant surgeon	When a minimal assistant surgeon role is documented and payer accepts modifier usage.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an advanced practice clinician acts as an assistant and the payer accepts modifier `AS` for payment.
`TC`	Technical component	Rare for a surgical procedure like appendectomy, but used when only the technical component of a bundled service is billed separately (e.g., unusual contractual arrangements).

Taxonomy Code	Specialty	Notes
`208600000X`	Surgery Physician	General surgeons commonly perform open appendectomy and are primary billers for `44950`.
`208800000X`	Colon & Rectal Surgery Physician	Colorectal surgeons may perform appendectomy when involved in complex lower abdominal pathology.
`208D00000X`	General Practice Physician	In some settings, general practitioners with surgical privileges may perform appendectomy; documentation must support privileges.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K35.80`	Acute appendicitis without perforation or gangrene	Typical indication for an urgent open appendectomy coded by `44950` when appendix is inflamed but not perforated.
`K35.2`	Acute appendicitis with generalized peritonitis	Indicates a more severe presentation; may require `44960` if rupture with generalized peritonitis is present, but still relevant to operative decision-making.
`K36`	Other appendicitis	Includes atypical or specified forms of appendicitis that may necessitate appendectomy.
`K37`	Unspecified appendicitis	Used when the record documents appendicitis but lacks specificity; supports the need for appendectomy when clinical documentation matches.
`K38.1`	Appendicular abscess	Represents localized abscess formation; may alter operative approach (drainage, more extensive exploration) and postoperative care.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`44955`	Appendectomy; when done for indicated purpose at time of other major procedure (not as separate procedure)	Used when an appendectomy is performed incident to another major abdominal procedure and not reported separately as the primary service.
`44960`	Appendectomy; for ruptured appendix with abscess or generalized peritonitis	Billed instead of `44950` when intraoperative findings include rupture with abscess or generalized peritonitis requiring more extensive management.
`49000`	Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) (separate procedure)	Performed when a full exploratory laparotomy is required for diagnosis or management; appendectomy may be performed during the same laparotomy.
`44180`	Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure)	Billed separately when significant adhesiolysis is required during an appendectomy and the service is distinct and documented.
`44120`	Enterectomy, resection of small intestine; single resection and anastomosis	Used when appendiceal disease necessitates resection of adjacent small bowel (e.g., severe inflammation, necrosis) in addition to appendectomy.

CPT 44955: Appendectomy Performed Incident to Another Major Procedure

CPT-44960-APPENDECTOMY-RUPTURED-APPENDIX-ABSCESS-PERITONITIS

CPT 44960: Appendectomy for Ruptured Appendix with Abscess or Peritonitis

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 44950: Appendectomy for Inflamed Appendix

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Billing Code Overview

National Reimbursement Benchmarks

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CPT 44950: Appendectomy for Inflamed Appendix

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Billing Code Overview

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

CPT 44950: Appendectomy for Inflamed Appendix

Sign up for cpt 44950 policy alerts

Billing Code Overview

National Reimbursement Benchmarks

CPT 44950: Appendectomy for Inflamed Appendix

Sign up for cpt 44950 policy alerts

Billing Code Overview

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What clinical scenario and setting does CPT 44950 cover?

How do reimbursement rates for CPT 44950 compare across payers?

Which modifiers are commonly referenced for CPT 44950 and when are they applicable?

What related CPT codes should be considered if intraoperative findings or concurrent procedures change the service performed?

Which ICD-10 diagnosis codes commonly map to CPT 44950, and how does diagnosis specificity affect coding?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What clinical scenario and setting does CPT 44950 cover?

How do reimbursement rates for CPT 44950 compare across payers?

Which modifiers are commonly referenced for CPT 44950 and when are they applicable?

What related CPT codes should be considered if intraoperative findings or concurrent procedures change the service performed?

Which ICD-10 diagnosis codes commonly map to CPT 44950, and how does diagnosis specificity affect coding?

References