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    OpenPayerBilling CodesExcision and Destruction Procedures on the Abdomen, Peritoneum, and OmentumCPT cpt-49189-open-abdominal-tumor-cyst-excision-20-1-30cm
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    CPT 49189: Open Excision/Destruction of Abdominal Tumors or Cysts (20.1–30 cm)

    Medicare pays $2165 on average nationally for this procedure.

    CPT code 49189 describes an open surgical procedure to excise or destroy one or more tumors or cysts located in the abdomen with a combined maximum lesion length of 20.1 to 30 cm; service type: open abdominal tumor/cyst excision or destruction; typical site of service: inpatient or outpatient hospital operating room for abdominal surgery.

    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.

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    Table of contents

    Progress1 / 7

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    Clinical & Coding Specifications

    Clinical Context

    A 58-year-old female presents with progressive abdominal distension and intermittent left lower quadrant discomfort. Imaging (CT abdomen/pelvis) demonstrates multiple intra-abdominal cystic masses whose summed maximum diameters measure 24 cm. Preoperative evaluation includes history and physical, lab studies (CBC, CMP), anesthesia assessment, and informed consent for open abdominal tumor/cyst excision. The patient is brought to a hospital operating room for an open laparotomy under general anesthesia. The surgical team performs exploration of the abdominal cavity, identifies the cystic masses adherent to omentum and bowel serosa, and excises the lesions with careful hemostasis. Estimated blood loss is recorded, specimens are sent for pathology, and the abdomen is irrigated and closed. Postoperative workflow includes recovery in PACU, inpatient monitoring for pain control and return of bowel function, pathology review, and discharge planning with follow-up for wound check and oncologic or gynecologic specialist management as indicated.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    49000Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) (separate procedure)Performed when diagnostic exploration is required before or during tumor/cyst excision
    49010Biopsy, retroperitoneal or intra-abdominal mass (separate procedure)May be used when only a biopsy is obtained rather than full excision
    44140Colectomy, partial; with anastomosis (separate procedure)May be performed if tumor involves colon requiring resection during same operation
    58720Salpingo-oophorectomy, unilateral or bilateral (separate procedure)Performed when ovarian cysts/tumors are the source and oophorectomy is required
    15734Muscle, myocutaneous, or fasciocutaneous flap; trunk (separate procedure)May be used for complex abdominal wall reconstruction if large resection requires soft-tissue repair

    Related Modifiers

    12 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…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    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…

    Showing 1–10 of 12

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208D00000X
    208000000X
    207P00000X
    363L00000X
    207RT0003X
    163WM0705X
    207VC0300X
    207YX0905X

    Related ICD-10-CM Codes

    23 rows

    ICD-10-CM CodeDescription
    C15.9Malignant neoplasm of esophagus, unspecified
    C16.9Malignant neoplasm of stomach, unspecified
    C18.9Malignant neoplasm of colon, unspecified
    C20Malignant neoplasm of rectum
    C48.1Malignant neoplasm of specified parts of peritoneum
    C48.2Malignant neoplasm of peritoneum, unspecified
    C56.9Malignant neoplasm of unspecified ovary
    C78.6Secondary malignant neoplasm of retroperitoneum and peritoneum
    C78.7Secondary malignant neoplasm of liver and intrahepatic bile duct
    D27.9Benign neoplasm of unspecified ovary

    Showing 1–10 of 23

    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-49187-OPEN-ABDOMINAL-TUMOR-CYST-EXCISION-5-1-10CM

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

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

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

    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.
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