Summary & Overview
CPT 49190: Open Excision/Destruction of Abdominal Tumors or Cysts, >30 cm
CPT code 49190 covers an open abdominal surgical procedure to excise or destroy one or more tumors or cysts when the total maximum length of the lesions is greater than 30 cm. This code captures a high-complexity operative intervention that has implications for surgical case complexity, inpatient resource use, and facility reimbursement. Nationally, accurate coding of large or multiple intra-abdominal masses supports appropriate payment and clinical documentation for major abdominal surgery.
Key payers addressed in the analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a clinical and billing overview of the procedure, typical sites of service, and the context in which the code is used. The content highlights how the code aligns with high-complexity open abdominal surgery and what aspects influence coding choice, such as lesion size thresholds specified in the descriptor.
This publication provides benchmarks and policy context relevant to payers and surgical providers, including common modifier usage and typical service-line considerations. It also outlines areas where documentation must support the use of 49190, and summarizes payer coverage patterns and coding implications at a national level. Data not available in the input is identified explicitly where applicable.
Billing Code Overview
CPT code 49190 describes an open surgical procedure to excise or destroy one or more tumors or cysts in the abdomen when the combined maximum lengths of the lesions exceed 30 cm. The service is a major open abdominal tumor/cyst excision or destruction performed by a surgical provider.
Service Type: Open surgical excision or destruction of abdominal tumors or cysts
Typical Site of Service: Hospital operating room or inpatient surgical setting
Data not available in the input.
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.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Default when no other modifier applies |