CPT 47100 Excisional Liver Biopsy Reimbursement

CPT code 47100 represents an excisional liver biopsy, a surgical diagnostic procedure in which a wedge-shaped portion of liver tissue is removed with a needle or surgical knife. The procedure is used to establish or confirm diagnoses of liver disease, stage disease severity, and monitor treatment response. Because liver biopsies can influence major clinical decisions—such as initiating or changing therapy for hepatitis, fibrosis, or other parenchymal liver disorders—accurate coding and documentation are important for clinical care and claims processing nationwide.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical indications and typical settings for the service, along with benchmarking context, common modifiers used in practice, and guidance on documentation elements that support medical necessity. The publication highlights national-level considerations for coding and billing workflows, including where the procedure is commonly performed (operating room or procedure suite, inpatient or outpatient) and why clear operative and pathology documentation matters for claim adjudication.

This summary is intended to orient clinicians, coding professionals, and policy analysts to the clinical role of CPT code 47100, the payer landscape addressed, and the types of benchmarks and policy-relevant details covered in the full publication. Data not available in the input is noted where applicable in subsequent sections.

Billing Code Overview

CPT code 47100 describes an excisional liver biopsy in which the provider removes a wedge-shaped section of liver tissue using a needle or a surgical knife. This procedure is performed to diagnose liver disease, assess disease severity, or monitor response to treatment.

Service type: Surgical diagnostic procedure (excisional liver biopsy)

Typical site of service: Operating room or procedure suite (inpatient or outpatient surgical setting).

Clinical Context

A 52-year-old patient with unexplained transaminitis and a history of chronic hepatitis C is referred to hepatology for tissue diagnosis. Noninvasive testing (imaging and serologies) has not established the etiology or stage of liver disease. The hepatologist schedules an excisional liver biopsy to obtain a wedge specimen for histopathology, special stains, and possible culture. The procedure is typically performed in an ambulatory surgical center or hospital operating room under conscious sedation or general anesthesia depending on patient comorbidities and planned concurrent procedures. The clinical workflow includes pre-procedure consent and coagulation assessment, peri-procedural anesthesia and sterile technique, procurement of the wedge specimen using a surgical knife or needle wedge technique, specimen submission to pathology with appropriate labeling (including requests for special stains or electron microscopy if indicated), post-procedure monitoring for bleeding or pain, and discharge with follow-up arranged to review pathology results and management planning.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	When work, time, or intensity substantially exceeds typical for `47100` and documentation supports additional work.

Taxonomy Code	Specialty	Notes
207RH0000X	General Surgery	General surgeons commonly perform open or wedge liver biopsy during abdominal operations.
207L00000X	Surgical Oncology	Surgical oncologists perform liver biopsies when evaluating focal hepatic lesions or staging malignancy.
207W00000X	Colon & Rectal Surgery	(Included when biopsies are performed during hepatic procedures in colorectal metastasis cases.)
207P00000X	Physician Assistant	APPs often assist and, where permitted, perform components of the procedure under supervision.
2080P0207X	Gastroenterology	Gastroenterologists may perform transjugular or laparoscopic wedge biopsies in coordination with interventional teams.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K76.9`	Liver disease, unspecified	General indication for biopsy when imaging and labs are nondiagnostic.
`K74.60`	Unspecified cirrhosis of liver	Biopsy may assess cirrhosis stage or etiology when noninvasive tests are inconclusive.
`B18.2`	Chronic viral hepatitis C	Common reason to stage fibrosis and inflammation via biopsy.
`K75.9`	Inflammatory liver disease, unspecified	Biopsy helps diagnose autoimmune or drug-induced hepatitis.
`R74.0`	Nonspecific elevation of levels of transaminase and lactic dehydrogenase	Persistent enzyme elevation may prompt biopsy to establish cause.
`C22.9`	Malignant neoplasm of liver, unspecified	Biopsy may be used to confirm primary or metastatic liver malignancy when imaging is indeterminate.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`32505`	Open pleural biopsy, with or without drainage	May be performed concurrently if thoracic exploration is required during abdominal surgery (contextual example).
`32601`	Thoracotomy with excision or biopsy of lung lesion	Listed as an example of another open biopsy procedure that may occur during multi-organ surgery; not typical with `47100`.
`49650`	Laparoscopy, surgical; abdominal resection or biopsy (single or multiple)	Laparoscopic approaches that include liver wedge biopsy or combined procedures, alternative approach to open wedge biopsy.
`49000`	Exploratory laparotomy, exploratory celiotomy with or without biopsy(s)	Often precedes or accompanies an open liver wedge biopsy when intra-abdominal evaluation is required.
`88305`	Level IV surgical pathology, gross and microscopic examination	Pathology CPT commonly billed for processing and examination of liver biopsy specimens obtained with `47100`.

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Summary & Overview

CPT 47100: Excisional Liver Biopsy (Wedge)