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    OpenPayerBilling CodesExcision and Destruction Procedures on the Abdomen, Peritoneum, and OmentumCPT cpt-49190-open-abdominal-tumor-cyst-excision-destruction-over-30cm
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    CPT 49190: Open Excision/Destruction of Abdominal Tumors or Cysts >30 cm

    Medicare pays $2662 on average nationally for this procedure.

    CPT code 49190 describes an open surgical procedure to excise or destroy one or more abdominal tumors or cysts when the combined maximum lengths of the lesions exceed 30 cm; the service is an open abdominal tumor/cyst excision or destruction and is typically performed in an operating room or inpatient surgical setting under appropriate anesthesia.

    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

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult presenting with one or more large intra-abdominal masses (benign or malignant) causing progressive abdominal distention, pain, early satiety, or obstructive symptoms. Preoperative evaluation includes cross-sectional imaging (CT or MRI) documenting the combined maximum linear dimension of the tumors/cysts exceeding 30 cm, laboratory studies, and surgical risk assessment. The patient is consented for an open exploratory laparotomy with excision or destruction of the tumor(s)/cyst(s). Intraoperative workflow commonly involves a midline laparotomy incision, careful mobilization of the mass(es), assessment for local invasion or adhesions, en bloc resection or cystectomy with appropriate hemostasis, inspection of the peritoneal cavity for additional lesions, and placement of drains as indicated. Postoperative care includes pain control, monitoring for hemorrhage or infection, pathology evaluation of the specimen, and coordination of follow-up oncology or gynecologic care if malignancy is confirmed. Typical sites of service are hospital inpatient or hospital outpatient (ambulatory surgery center use is uncommon for masses this large). The service type is open abdominal tumor/cyst excision or destruction.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    49000Repair, initial, of incisional or ventral hernia; reducibleMay be performed concurrently if tumor resection requires hernia repair or fascial closure reinforcement
    49585Repair initial incisional or ventral hernia, including mesh, when performed with other major surgeryUsed when hernia repair with mesh is required at the time of tumor excision
    47562Laparoscopy, surgical, cholecystectomy with cholangiographyMay be performed separately or before open procedures if biliary evaluation is needed; not routine with 49190 but listed as related abdominal surgery
    49010Drainage of abdominal/pelvic abscess; open or percutaneousMay be performed if infected cysts or abscesses are encountered and require drainage
    32505Thoracotomy for diagnostic and therapeutic procedures (separate chest procedure)Relevant when tumor extends into thoracic cavity and a chest procedure is required as part of the operative plan
    11043Debridement, skin, subcutaneous tissue, and muscle when extensiveMay be used if large soft-tissue resection or debridement of abdominal wall is necessary during tumor excision

    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…
    54Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
    55Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
    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…
    63Modifier‑63 is appended to surgical CPT codes (20000–69990) when a procedure is performed on a neonate or infant weighing ≤ 4 kg (about 8.8 lbs). The AMA/AAPC definition specifies this use and notes…- Use modifier -63 only for surgical procedures in the CPT 20000–69990 series performed on a neonate or infant who weighs ≤ 4 kg at the time of the procedure; it indicates increased complexity due to…

    Showing 1–10 of 12

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208100000X
    208600000X
    207V00000X
    208000000X
    2084P0800X
    261QL0400X
    224Y00000X
    320600000X

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

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