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CPT 48146: Near Total Pancreatectomy, Major Abdominal Surgery

CPT code 48146 denotes a near total pancreatectomy, a major abdominal operation removing most of the pancreas. This procedure is clinically significant for patients with diffuse or extensive pancreatic pathology where preservation of minimal pancreatic tissue is planned. Nationally, billing and coverage for high-complexity pancreatic resections like this affect hospital surgical services, inpatient resource utilization, and specialty surgical care pathways.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for 48146, common payer coverage considerations, and benchmarking topics relevant to high-acuity surgical billing. The publication addresses coding specificity, typical settings of service, and implications for inpatient surgical resource allocation.

The report provides practical reference material: a concise description of the procedure and service line, payer coverage list, typical sites of service, and points of focus for revenue cycle and clinical operations. Data not available in the input are noted where applicable. The content is intended for health system administrators, clinical coders, and policy analysts seeking a national-level summary of CPT code 48146 and its role in surgical care and billing workflows.

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Billing Code Overview

CPT code 48146 describes a near total pancreatectomy, a surgical procedure in which the provider removes most of the pancreas. The service is a major abdominal surgical operation performed to treat extensive pancreatic disease when preservation of only a small portion of pancreatic tissue is intended.

Service type: Major abdominal surgical procedure
Typical site of service: Hospital inpatient operating room or other inpatient surgical setting

Find policies, billing codes, payers, states, and providers

CPT 48146: Near Total Pancreatectomy, Major Abdominal Surgery

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Billing Code Overview

Service type: Major abdominal surgical procedure
Typical site of service: Hospital inpatient operating room or other inpatient surgical setting

Clinical & Coding Specifications

Clinical Context

A 52-year-old patient with a history of multifocal, non-resectable pancreatic neuroendocrine tumor presents with progressive endocrine dysfunction and refractory abdominal pain. After multidisciplinary tumor board review and failed attempts at organ-preserving therapy, the surgical team schedules a near total pancreatectomy to remove the majority of the pancreas while preserving minimal pancreatic tissue to maintain some endocrine/exocrine function.

Preoperative workflow includes cross-sectional imaging (CT or MRI), endocrine and nutritional assessment, optimization of glycemic control, informed consent covering risks (bleeding, infection, pancreatic fistula, brittle diabetes), and coordination with anesthesia and blood bank for potential transfusion. Intraoperative workflow involves laparotomy or minimally invasive access, dissection of pancreatic tissue, vascular control, possible splenectomy depending on oncologic margins and vascular involvement, reconstruction as indicated, placement of drains, and hemostasis. Postoperative management focuses on intensive monitoring, pain control, glycemic management (insulin therapy), enzyme supplementation, infection surveillance, and discharge planning with endocrine and nutrition follow-up.

Coding Specifications

Modifier	Description	When to Use
`00`	Procedural modifier for unspecified purpose (payer-specific use)	Rarely used; follow payer guidance when no other modifier applies
`11`	Office or other outpatient visit (global fee related modifier)	Use when reporting an initial global service period modifier per payer rules if required
`22`	Increased procedural services	Use when the near total pancreatectomy requires substantially greater effort, time, or technical difficulty than typical; documentation must support increased payment
`23`	Unusual anesthesia	Use when general anesthesia is not used and the procedure required anesthesia that is substantially different or unusually deep for the setting
`26`	Professional component	Use when reporting only the surgeon’s professional component separate from facility billing (rare for operative CPTs billed by facility)
`50`	Bilateral procedure	Not typically applicable to pancreatic resection; include only if payer-specific guidance requires bilateral modifier for procedures affecting paired organs
`51`	Multiple procedures	Use when additional unrelated surgical procedures are performed during the same operative session alongside the near total pancreatectomy
`52`	Reduced services	Use when the procedure is partially reduced or not completed as originally intended, with documentation of the limitation
`53`	Discontinued procedure	Use when the near total pancreatectomy is started but terminated due to extenuating circumstances; operative report must explain reason
`54`	Surgical care only	Use when the surgeon bills only for the intraoperative portion and another provider bills postoperative care
`55`	Postoperative management only	Use when billing only for postoperative follow-up management when another surgeon performed the operation
`62`	Two surgeons	Use when two surgeons of different specialties work together as primary surgeons performing distinct and documented portions of the near total pancreatectomy
`63`	Procedure performed on infants less than 4 kg	Not typical for adult near total pancreatectomy; include only in pediatric cases meeting weight criteria
`80`	Assistant surgeon	Use when a qualified assistant surgeon participates and is billing for assistance in the operation

Taxonomy Code	Specialty	Notes
`408500000X`	General Surgery	Most common specialty performing near total pancreatectomy for tumors or chronic pancreatitis
`208000000X`	General Surgery - Surgical Oncology	Surgical oncologists frequently perform complex pancreatic resections for malignancy
`207K00000X`	Colon & Rectal Surgery (general surgical training applicable)	May be involved when multivisceral resection or colorectal involvement is present
`207L00000X`	Vascular Surgery	Consulted when major vascular reconstruction of mesenteric or portal vessels is required
`363LF0000X`	Pediatric Surgery	Performs pancreatectomy in pediatric patients when clinically indicated

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C25.9`	Malignant neoplasm of pancreas, unspecified	Primary indication for near total pancreatectomy when tumor is extensive and not amenable to limited resection
`C25.4`	Malignant neoplasm of head of pancreas	Tumors in the pancreatic head that are large or multifocal may necessitate extensive resection approaching near total pancreatectomy
`C25.7`	Malignant neoplasm of other parts of pancreas	Tumors in body/tail with multifocal disease or local invasion requiring extensive pancreatic resection
`K86.1`	Chronic pancreatitis	Severe, refractory chronic pancreatitis with diffuse gland destruction may be an indication for near total pancreatectomy to relieve pain and complications
`E10.9`	Type 1 diabetes mellitus without complications	Pre-existing endocrine dysfunction influences perioperative planning and postoperative insulin management; pancreatectomy will exacerbate insulin dependence
`E11.9`	Type 2 diabetes mellitus without complications	Common comorbidity affecting perioperative glycemic control and long-term metabolic outcomes after resection
`K91.83`	Postprocedural pancreatic fistula	Known postoperative complication; documentation supports drainage or reoperation codes if treated
`R10.9`	Abdominal pain, unspecified	Symptom leading to diagnostic workup that may culminate in surgical intervention when pain is due to advanced pancreatic disease

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`48146`	Near total pancreatectomy (primary code)	Primary operative code describing removal of most of the pancreas
`38100`	Splenectomy, total, without autotransplantation	Often performed concurrently if splenic vessels or oncologic margins require removal of the spleen during a near total pancreatectomy
`44005`	Enterolysis (lysis of peritoneal adhesions)	Performed when dense adhesions are encountered intraoperatively and require lysis to gain access to the pancreas
`34830`	Reconstruction of portal vein (interposition graft)	Performed when tumor invades portal or mesenteric veins requiring vascular resection and reconstruction during pancreatectomy
`49406`	Insertion of intra-abdominal drainage device (percutaneous)	Used for management of postoperative pancreatic fluid collections or for placement of drains intraoperatively if required
`99291`	Critical care, evaluation and management of the critically ill or critically injured patient, first 30–74 minutes	May be reported for immediate postoperative critical care management in the ICU following a complex near total pancreatectomy

CPT 48100: Open Surgical Biopsy of Pancreatic Lesion

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

CPT 48102: Percutaneous Pancreatic Needle Biopsy, Tissue for Pathology

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

CPT 48105: Pancreatic Resection and Debridement for Acute Necrotizing Pancreatitis

CPT-48120-PANCREATIC-LESION-EXCISION

CPT 48120: Excision of Pancreatic Lesion

CPT-48140-DISTAL-PANCREATECTOMY-WITHOUT-PANCREATICOJEJUNOSTOMY

CPT 48140: Distal Pancreatectomy, With or Without Splenectomy

CPT-48145-DISTAL-PANCREATECTOMY-WITH-OR-WITHOUT-SPLENECTOMY

CPT 48145: Distal Pancreatectomy With or Without Splenectomy

CPT-48148-AMPULLA-OF-VATER-REMOVAL-AMPULLECTOMY

CPT 48148: Removal of Ampulla of Vater (Ampullectomy)

CPT-48150-PANCREATICODUODENECTOMY-PYLORUS-RESECTING

CPT 48150: Pancreaticoduodenectomy with Distal Stomach Resection

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

CPT 48152: Subtotal Pancreatectomy with Duodenectomy and Reconstruction

CPT-48153-PANCREATICODUODENAL-RESECTION-WITH-RECONSTRUCTION

CPT 48153: Pancreaticoduodenal Resection with Biliary and Pancreatic Reconstruction

Showing 1–10 of 13

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
`00`	Procedural modifier for unspecified purpose (payer-specific use)	Rarely used; follow payer guidance when no other modifier applies
`11`	Office or other outpatient visit (global fee related modifier)	Use when reporting an initial global service period modifier per payer rules if required
`22`	Increased procedural services	Use when the near total pancreatectomy requires substantially greater effort, time, or technical difficulty than typical; documentation must support increased payment
`23`	Unusual anesthesia	Use when general anesthesia is not used and the procedure required anesthesia that is substantially different or unusually deep for the setting
`26`	Professional component	Use when reporting only the surgeon’s professional component separate from facility billing (rare for operative CPTs billed by facility)
`50`	Bilateral procedure	Not typically applicable to pancreatic resection; include only if payer-specific guidance requires bilateral modifier for procedures affecting paired organs
`51`	Multiple procedures	Use when additional unrelated surgical procedures are performed during the same operative session alongside the near total pancreatectomy
`52`	Reduced services	Use when the procedure is partially reduced or not completed as originally intended, with documentation of the limitation
`53`	Discontinued procedure	Use when the near total pancreatectomy is started but terminated due to extenuating circumstances; operative report must explain reason
`54`	Surgical care only	Use when the surgeon bills only for the intraoperative portion and another provider bills postoperative care
`55`	Postoperative management only	Use when billing only for postoperative follow-up management when another surgeon performed the operation
`62`	Two surgeons	Use when two surgeons of different specialties work together as primary surgeons performing distinct and documented portions of the near total pancreatectomy
`63`	Procedure performed on infants less than 4 kg	Not typical for adult near total pancreatectomy; include only in pediatric cases meeting weight criteria
`80`	Assistant surgeon	Use when a qualified assistant surgeon participates and is billing for assistance in the operation

Taxonomy Code	Specialty	Notes
`408500000X`	General Surgery	Most common specialty performing near total pancreatectomy for tumors or chronic pancreatitis
`208000000X`	General Surgery - Surgical Oncology	Surgical oncologists frequently perform complex pancreatic resections for malignancy
`207K00000X`	Colon & Rectal Surgery (general surgical training applicable)	May be involved when multivisceral resection or colorectal involvement is present
`207L00000X`	Vascular Surgery	Consulted when major vascular reconstruction of mesenteric or portal vessels is required
`363LF0000X`	Pediatric Surgery	Performs pancreatectomy in pediatric patients when clinically indicated

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C25.9`	Malignant neoplasm of pancreas, unspecified	Primary indication for near total pancreatectomy when tumor is extensive and not amenable to limited resection
`C25.4`	Malignant neoplasm of head of pancreas	Tumors in the pancreatic head that are large or multifocal may necessitate extensive resection approaching near total pancreatectomy
`C25.7`	Malignant neoplasm of other parts of pancreas	Tumors in body/tail with multifocal disease or local invasion requiring extensive pancreatic resection
`K86.1`	Chronic pancreatitis	Severe, refractory chronic pancreatitis with diffuse gland destruction may be an indication for near total pancreatectomy to relieve pain and complications
`E10.9`	Type 1 diabetes mellitus without complications	Pre-existing endocrine dysfunction influences perioperative planning and postoperative insulin management; pancreatectomy will exacerbate insulin dependence
`E11.9`	Type 2 diabetes mellitus without complications	Common comorbidity affecting perioperative glycemic control and long-term metabolic outcomes after resection
`K91.83`	Postprocedural pancreatic fistula	Known postoperative complication; documentation supports drainage or reoperation codes if treated
`R10.9`	Abdominal pain, unspecified	Symptom leading to diagnostic workup that may culminate in surgical intervention when pain is due to advanced pancreatic disease

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`48146`	Near total pancreatectomy (primary code)	Primary operative code describing removal of most of the pancreas
`38100`	Splenectomy, total, without autotransplantation	Often performed concurrently if splenic vessels or oncologic margins require removal of the spleen during a near total pancreatectomy
`44005`	Enterolysis (lysis of peritoneal adhesions)	Performed when dense adhesions are encountered intraoperatively and require lysis to gain access to the pancreas
`34830`	Reconstruction of portal vein (interposition graft)	Performed when tumor invades portal or mesenteric veins requiring vascular resection and reconstruction during pancreatectomy
`49406`	Insertion of intra-abdominal drainage device (percutaneous)	Used for management of postoperative pancreatic fluid collections or for placement of drains intraoperatively if required
`99291`	Critical care, evaluation and management of the critically ill or critically injured patient, first 30–74 minutes	May be reported for immediate postoperative critical care management in the ICU following a complex near total pancreatectomy

CPT 48100: Open Surgical Biopsy of Pancreatic Lesion

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

CPT 48102: Percutaneous Pancreatic Needle Biopsy, Tissue for Pathology

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

CPT 48105: Pancreatic Resection and Debridement for Acute Necrotizing Pancreatitis

CPT-48120-PANCREATIC-LESION-EXCISION

CPT 48120: Excision of Pancreatic Lesion

CPT-48140-DISTAL-PANCREATECTOMY-WITHOUT-PANCREATICOJEJUNOSTOMY

CPT 48140: Distal Pancreatectomy, With or Without Splenectomy

CPT-48145-DISTAL-PANCREATECTOMY-WITH-OR-WITHOUT-SPLENECTOMY

CPT 48145: Distal Pancreatectomy With or Without Splenectomy

CPT-48148-AMPULLA-OF-VATER-REMOVAL-AMPULLECTOMY

CPT 48148: Removal of Ampulla of Vater (Ampullectomy)

CPT-48150-PANCREATICODUODENECTOMY-PYLORUS-RESECTING

CPT 48150: Pancreaticoduodenectomy with Distal Stomach Resection

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

CPT 48152: Subtotal Pancreatectomy with Duodenectomy and Reconstruction

CPT-48153-PANCREATICODUODENAL-RESECTION-WITH-RECONSTRUCTION

CPT 48153: Pancreaticoduodenal Resection with Biliary and Pancreatic Reconstruction

Showing 1–10 of 13

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.

OpenPayer

CPT 48146: Near Total Pancreatectomy, Major Abdominal Surgery

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Billing Code Overview

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CPT 48146: Near Total Pancreatectomy, Major Abdominal Surgery

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Billing Code Overview

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