CPT 49187 Reimbursement & Benchmarks | OpenPayer

Summary & Overview

CPT 49187: Open Abdominal Tumor or Cyst Excision, 5.1–10 cm

CPT code 49187 covers open surgical excision or destruction of one or more abdominal tumors or cysts with a combined maximum length of 5.1 to 10 cm. Nationally, this code captures intermediate-size lesion resections performed via an open abdominal approach and is relevant for surgical specialties managing intra-abdominal masses. It distinguishes procedures by lesion size, which affects coding selection, clinical documentation, and institutional billing workflows.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical scope of the code, how it differentiates from smaller or larger lesion excisions, and which service settings commonly provide the procedure. The publication also summarizes typical benchmarks and policy considerations that influence coverage and payment for open abdominal tumor or cyst excisions, and highlights documentation elements important for proper coding.

This overview is intended to inform billing staff, surgical clinicians, and revenue cycle professionals about the clinical meaning of the code, payer coverage context, and the operational implications for reporting CPT code 49187. Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and service line.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 49187open abdominal surgerytumor excisionsurgical oncologyoperative codingprocedure size-based codinghospital surgeryambulatory surgical centerbilling guidance

Billing Code Overview

CPT code 49187 describes an open surgical procedure to excise or destroy one or more tumors or cysts in the abdomen when the combined maximum length of the lesions is 5.1 to 10 cm. This procedure involves a direct (open) abdominal approach to remove or ablate abdominal masses.

Service type: Open abdominal tumor or cyst excision/destruction

Typical site of service: Hospital operating room or ambulatory surgical center, where open abdominal surgeries are performed.

Clinical & Coding Specifications

Clinical Context

A 52-year-old patient presents with intermittent abdominal discomfort and a palpable mass on examination. Imaging with abdominal ultrasound and contrast-enhanced CT identifies multiple intra-abdominal cystic/tumorous lesions whose summed maximum longitudinal diameters measure approximately 6.2 cm. The surgical team schedules an open exploratory laparotomy for excision of the lesions. Preoperative workflow includes history and physical, informed consent explaining open excision, preoperative labs and anesthesia evaluation, and appropriate perioperative prophylaxis. Intraoperatively, the surgeon performs an open abdominal approach, isolates and excises one or more tumors/cysts with total maximum lengths between 5.1 and 10.0 cm, achieves hemostasis, and sends specimens to pathology. Postoperative workflow includes recovery room monitoring, pain control, wound care instructions, and pathology follow-up to guide further oncologic or medical management.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work, time, or effort substantially exceeds typical for `49187` and documentation supports the increased work.
`23`

CPT 49255: Omentectomy for Metastatic Abdominal or Pelvic Cancer

CPT-49215-SACROCOCCYGEAL-MASS-EXCISION

CPT 49215: Excision of Sacrococcygeal Mass

CPT-49188-OPEN-EXCISION-ABDOMINAL-TUMORS-10-1-20-CM

CPT 49188: Open Excision/Destruction of Abdominal Tumors or Cysts (10.1–20 cm)

CPT-49185-PERCUTANEOUS-CHEMICAL-DESTRUCTION-FLUID-COLLECTION

CPT 49185: Percutaneous Chemical Destruction of Fluid Collection

CPT-49250-UMBILICAL-EXCISION-HERNIA-INFECTION

CPT 49250: Excision of Umbilicus for Hernia or Nonhealing Infection

CPT-49189-OPEN-ABDOMINAL-TUMOR-CYST-EXCISION-20-1-30CM

CPT 49189: Open Excision/Destruction of Abdominal Tumors or Cysts

CPT-49180-PERCUTANEOUS-ABDOMINAL-NEEDLE-BIOPSY

CPT 49180: Percutaneous Abdominal Needle Biopsy

CPT-49190-OPEN-ABDOMINAL-TUMOR-CYST-EXCISION-DESTRUCTION-OVER-30CM

CPT 49190: Open Excision/Destruction of Abdominal Tumors or Cysts, >30 cm

CPT-49186-OPEN-ABDOMINAL-EXCISION-DESTRUCTION-SMALL-TUMORS-CYSTS

CPT 49186: Open Excision/Destruction of Small Abdominal Tumors or Cysts

Taxonomy Code	Specialty	Notes
208100000X	General Surgery	Most common specialty performing open abdominal tumor/cyst excisions.
208000000X	Colon and Rectal Surgery	May perform excision if lesions involve colorectal structures.
208600000X	Surgical Oncology	Performs oncologic resections for suspected malignant abdominal tumors.
207P00000X	Obstetrics & Gynecology	Performs abdominal cyst/tumor excision when adnexal or gynecologic in origin.
207L00000X	Urology	Performs open excision when lesions involve urologic organs (e.g., retroperitoneal near kidneys).

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.	Data not available in the input.	Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`49000`	Exploratory laparotomy, exploratory celiotomy with or without repair, initial procedure	Performed when diagnosis is uncertain prior to `49187`; may be the access procedure preceding targeted excision.
`58720`	Excision of adnexal mass, abdominal approach	Used when the excised cyst/tumor arises from adnexa; may be coded instead of or in addition to `49187` depending on site and documentation.
`49200`	Excision, retroperitoneal tumor, open approach	Related when tumor is retroperitoneal; may represent anatomic-specific alternative code to `49187`.
`20220`	Excision of soft tissue tumor of neck, subcutaneous; 3 cm or less (example of size-based soft tissue excision code)	Size-based excision codes illustrate coding dependent on summed lesion size; used for comparison when multiple lesions of different anatomic sites are excised.
`19301`	Partial mastectomy (lumpectomy), single lesion	Example of lesion-directed excision code in another anatomic region—illustrates principle of lesion size and count affecting code selection in surgical coding workflows.

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