CPT 48120 Pancreatic Lesion Excision Reimbursement | OpenPayer

Summary & Overview

CPT 48120: Excision of Pancreatic Lesion

CPT code 48120 represents surgical removal of a lesion of the pancreas — a focused operative procedure used for diagnostic and therapeutic management of pancreatic masses. Nationally, pancreatic surgery is clinically significant due to the complex perioperative needs, potential for malignancy, and resource intensity of care. This code captures discrete lesion excision distinct from more extensive pancreatic resections.

Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical role, typical site-of-service settings, and which national payers commonly process claims for this service. The publication provides benchmarks and comparative coverage context, highlights clinical considerations tied to operative management of pancreatic lesions, and summarizes relevant coding relationships and utilization patterns where available.

The coverage will help billing managers, surgical practices, and policy analysts understand how CPT code 48120 is used in claims, what to expect from major payers, and where to look for additional policy or reimbursement detail. Data not available in the input will be noted explicitly in relevant sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 48120pancreatic surgerypancreatic lesion excisionsurgical procedurehospital surgeryoperative codinggastrointestinal surgerymedical billing

Billing Code Overview

CPT code 48120 describes a procedure in which the provider removes a lesion of the pancreas. This service is a surgical excision of a pancreatic lesion, typically performed to diagnose or treat focal pancreatic masses or tumors.

Service type: Surgical procedure
Typical site of service: Hospital operating room or surgical suite (inpatient or outpatient surgical setting)

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult referred to a surgical oncology team for resection of a focal pancreatic lesion detected on imaging. Presentation commonly includes abdominal pain, unexplained weight loss, jaundice, or incidental finding on CT or MRI. Preoperative workup includes cross-sectional imaging (contrast-enhanced CT or MRI), endoscopic ultrasound with possible biopsy, laboratory evaluation including liver function tests and tumor markers (eg, CA 19-9), and anesthesia assessment.

The operation coded by 48120 involves surgical removal of a lesion of the pancreas and may be performed via open or minimally invasive approaches depending on lesion location and patient factors. The typical site of service is an inpatient operating room within an acute care hospital; select cases may be performed in ambulatory surgical centers when criteria are met and observation or short-stay admission is planned. Perioperative workflow includes preoperative consent and documentation of indication, intraoperative operative note describing lesion size/location, approach, extent of resection, and reconstruction if performed, and postoperative progress notes documenting recovery, complications, and discharge planning. Pathology specimen handling and final pathology report are part of the clinical course.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services

CPT 48145: Distal Pancreatectomy With or Without Splenectomy

CPT-48105-PANCREATIC-RESECTION-DEBRIDEMENT-ACUTE-NECROTIZING-PANCREATITIS

CPT 48105: Pancreatic Resection and Debridement for Acute Necrotizing Pancreatitis

CPT-48100-OPEN-SURGICAL-PANCREATIC-BIOPSY-PATHOLOGY-SAMPLE

CPT 48100: Open Surgical Biopsy of Pancreatic Lesion

CPT-48152-SUBTOTAL-PANCREATECTOMY-DUODENECTOMY-WITH-RECONSTRUCTION-NO-PANCREATICOJEJUNOSTOMY

CPT 48152: Subtotal Pancreatectomy with Duodenectomy and Reconstruction

CPT-48160-PANCREATECTOMY-WITH-PANCREATIC-TISSUE-OR-ISLET-TRANSPLANT

CPT 48160: Pancreatectomy with Pancreatic Tissue or Islet Transplant

CPT-48155-TOTAL-PANCREATECTOMY-COMPLETE-PANCREAS-REMOVAL

CPT 48155: Total Pancreatectomy, Complete Removal of Pancreas

CPT-48140-DISTAL-PANCREATECTOMY-WITHOUT-PANCREATICOJEJUNOSTOMY

CPT 48140: Distal Pancreatectomy, With or Without Splenectomy

CPT-48153-PANCREATICODUODENAL-RESECTION-WITH-RECONSTRUCTION

CPT 48153: Pancreaticoduodenal Resection with Biliary and Pancreatic Reconstruction

CPT-48146-NEAR-TOTAL-PANCREATECTOMY

CPT 48146: Near Total Pancreatectomy, Major Abdominal Surgery

CPT-48102-PERCUTANEOUS-PANCREATIC-NEEDLE-BIOPSY-PATHOLOGY

CPT 48102: Percutaneous Pancreatic Needle Biopsy, Tissue for Pathology

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Taxonomy Code	Specialty	Notes
208000000X	General Surgery	Most common specialty performing pancreatic lesion resections.
208600000X	Surgical Oncology	Specialized management of pancreatic neoplasms and complex oncologic resections.
207L00000X	Colon & Rectal Surgery	May participate when multivisceral resection involves colorectal structures.
208C00000X	Cardiothoracic Surgery	Included for complex resections involving posterior mediastinum extension in rare cases.
330L00000X	Transplant Surgery	May be involved for complex pancreatic disease linked to transplant procedures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C25.9`	Malignant neoplasm of pancreas, unspecified	Represents pancreatic cancer that may require lesion resection when localized and resectable.
`D13.6`	Benign neoplasm of pancreas	Benign pancreatic tumors (eg, serous cystadenoma) that may be excised for symptoms or size.
`K86.2`	Cyst of pancreas	Pancreatic cystic lesions that can be symptomatic or suspicious for neoplasm leading to resection.
`K86.1`	Other cysts of pancreas	Includes congenital or acquired cystic lesions requiring surgical management.
`R10.11`	Right upper quadrant pain	Symptom prompting imaging that may identify a pancreatic lesion.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`48140`	Pancreatectomy, distal subtotal, with or without splenectomy	Performed when lesion location necessitates distal pancreatectomy rather than localized lesion excision.
`48145`	Partial pancreatectomy, with pancreatoenterostomy	Performed when resection requires reconstruction of pancreatic drainage.
`47562`	Laparoscopy, surgical; cholecystectomy	May be performed concomitantly if symptomatic gallbladder disease or biliary stent management is required.
`43238`	Upper gastrointestinal endoscopy with biopsy, single or multiple	Performed preoperatively via endoscopic ultrasound-guided biopsy to obtain tissue diagnosis.
`88309`	Surgical pathology, gross and microscopic examination	Associated with analysis of the resected pancreatic lesion specimen.

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