Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.30
    OpenPayerBilling CodesExcision and Destruction Procedures on the Abdomen, Peritoneum, and OmentumCPT cpt-49187-open-abdominal-tumor-cyst-excision-5-1-10cm
    Ask Trek AI about this page

    CPT 49187: Open Excision or Destruction of Abdominal Tumors/Cysts, 5.1–10 cm

    Medicare pays $1560 on average nationally for this procedure.

    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 measures 5.1 to 10 cm; the service is an open abdominal tumor/cyst excision or destruction typically performed in an inpatient or outpatient surgical setting (operating room or procedure suite) and involves removal or destruction of lesions through an open abdominal approach.

    For related coverage guidance, see recent payer policy updates: Surgical Procedures, Outpatient Surgical Procedures - Site of Service, Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in Adults.

    Customize your policy alerts

    Sign up for cpt 49187 policy alerts

    Get alerted when payer policies referencing 49187 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Table of contents

    Progress1 / 7

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • Facility ComparisonBeds, revenue & payer mix
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    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.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    49000Exploratory laparotomy, exploratory celiotomy with or without repair, initial procedurePerformed when diagnosis is uncertain prior to 49187; may be the access procedure preceding targeted excision.
    58720Excision of adnexal mass, abdominal approachUsed when the excised cyst/tumor arises from adnexa; may be coded instead of or in addition to 49187 depending on site and documentation.
    49200Excision, retroperitoneal tumor, open approachRelated when tumor is retroperitoneal; may represent anatomic-specific alternative code to 49187.
    20220Excision 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.
    19301Partial mastectomy (lumpectomy), single lesionExample of lesion-directed excision code in another anatomic region—illustrates principle of lesion size and count affecting code selection in surgical coding workflows.

    Related Modifiers

    11 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    81Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…

    Showing 1–10 of 11

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208100000X
    208000000X
    208600000X
    207P00000X
    207L00000X
    225XP0019X
    363A00000X
    2470A2800X

    Related ICD-10-CM Codes

    25 rows

    ICD-10-CM CodeDescription
    C18.9Malignant neoplasm of colon, unspecified
    C48.1Malignant neoplasm of specified parts of peritoneum
    C48.2Malignant neoplasm of peritoneum, unspecified
    C76.2Malignant neoplasm of abdomen
    C78.7Secondary malignant neoplasm of liver and intrahepatic bile duct
    D12.0Benign neoplasm of cecum
    D12.6Benign neoplasm of colon, unspecified
    D12.7Benign neoplasm of rectosigmoid junction
    K31.89Other diseases of stomach and duodenum
    K57.20Diverticulitis of large intestine with perforation and abscess without bleeding

    Showing 1–10 of 25

    Related Payer Policy Updates

    Specialty: General Surgery1 / 2

    10 rows

    PolicyPayerEffective Date
    Surgical ProceduresUnitedHealthcare2026-09-01
    Outpatient Surgical Procedures - Site of ServiceUnitedHealthcare2026-09-01
    Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsPremera Bluecross2026-09-01
    Site of Service Ambulatory Surgical Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsPremera Bluecross2026-09-01
    Site of Service Ambulatory Service Center (ASC) SelectPremera Bluecross2026-09-01
    Site of Service Ambulatory Surgical Center (ASC) Select — Site of Service for Ambulatory Surgical Procedures (ASC Select)Premera Bluecross2026-09-01
    Site of Service Ambulatory Service Center (ASC) SelectPremera Bluecross2026-09-01
    Outpatient Surgical Procedures - Site of Servicesierra health and life2026-08-01
    Medical Necessity Guidelines — Inpatient Surgical CareMass General Brigham Health Plan2026-08-01
    Ambulatory Surgery Center (ASC) - Site of Care PolicyKaiser Permanente2026-08-01

    Related Codes

    CPT-49180-PERCUTANEOUS-ABDOMINAL-NEEDLE-BIOPSY

    CPT 49180: Percutaneous Abdominal/Retroperitoneal Needle Biopsy

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

    CPT 49185: Percutaneous Chemical Destruction of Fluid Collection

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

    CPT 49186: Open Excision/Destruction of Abdominal Tumors or Cysts ≤5 cm

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

    CPT 49188: Open Abdominal Excision/Destruction of Tumor(s)/Cyst(s)

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

    CPT 49189: Open Excision/Destruction of Abdominal Tumors or Cysts (20.1–30 cm)

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

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

    CPT-49215-SACROCOCCYGEAL-MASS-EXCISION

    CPT 49215: Excision of Sacrococcygeal Tumor

    CPT-49250-UMBILICAL-EXCISION-HERNIA-INFECTION

    CPT 49250: Excision of Umbilicus (Umbilectomy)

    CPT-49255-OMENTECTOMY-FOR-METASTATIC-ABDOMINAL-PELVIC-CANCER

    CPT 49255: Omentectomy, Excision of Omentum for Metastatic Disease

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
    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.