CPT 49215 Sacrococcygeal Mass Excision Reimbursement | OpenPayer

Summary & Overview

CPT 49215: Excision of Sacrococcygeal Mass

CPT code 49215 represents surgical excision of an abnormal mass in the sacrococcygeal region near the base of the spine, a procedure most often relevant for newborns with sacrococcygeal tumors. This code captures a relatively specialized pediatric surgical service used for both diagnostic and therapeutic management of benign and malignant lesions in the coccygeal area. Nationally, accurate coding for 49215 matters for clinical documentation, resource planning, and appropriate payment for perioperative and inpatient services associated with complex neonatal or pediatric surgery.

Key payers in the coverage landscape include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for the procedure, typical sites of service, and what to expect in claims workflow when this code is billed. The publication also highlights benchmarking and policy considerations relevant to hospital and surgical departments, clinical documentation essentials tied to diagnosis and surgical findings, and potential areas where prior authorization or utilization management commonly arises.

Data not available in the input for detailed payer-specific reimbursement rates, associated taxonomies, ICD-10 mappings, and related code groupings. The content is intended to provide a national-level clinical and billing orientation to CPT code 49215 for clinicians, coding professionals, and policy analysts.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare49215CPTsurgical-excisionsacrococcygeal-tumorpediatric-surgeryoperating-roomdiagnostic-surgery

Billing Code Overview

CPT code 49215 describes the surgical removal of an abnormal mass located in the sacrococcygeal region near the base of the spine. The procedure is performed to treat or obtain tissue for diagnosis of benign or malignant tumors. Sacrococcygeal tumors most commonly involve newborns, though presentation can vary by age and clinical context.

Service type: Surgical excision of a sacrococcygeal mass
Typical site of service: Operating room or surgical suite, with potential inpatient or outpatient admission depending on patient age, clinical complexity, and perioperative needs

Data not available in the input for payers, associated taxonomies, ICD-10 diagnoses, related codes, and service line.

Clinical & Coding Specifications

Clinical Context

A typical patient is a neonate or young infant presenting with a palpable sacrococcygeal mass discovered at birth or on newborn exam, sometimes identified prenatally on ultrasound. The mass may cause constipation, urinary retention, skin irritation, infection, or be suspected of harboring malignant elements (e.g., yolk sac tumor). Initial evaluation includes physical exam, pelvic ultrasound and/or MRI to define extent and relation to pelvic structures, baseline labs including alpha‑fetoprotein when malignancy is suspected, and multidisciplinary consultation (pediatric surgery, pediatric neurosurgery, pediatric oncology as indicated). The operative workflow often includes preoperative anesthesia evaluation, positioning for posterior approach, surgical excision of the sacrococcygeal tumor with preservation of sphincter function when possible, intraoperative frozen section if indicated, and specimen sent to pathology. Postoperative care includes pain management, wound care, monitoring for neurologic or urologic deficits, and oncology follow‑up if malignancy is confirmed. Coding for the definitive excision uses 49215 for sacrococcygeal tumor resection; perioperative modifiers and relevant global period rules are applied per payer policy.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the procedure requires substantially greater work than typical due to extensive dissection, large tumor size, or significant intraoperative complexity.

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

CPT-49250-UMBILICAL-EXCISION-HERNIA-INFECTION

CPT 49250: Excision of Umbilicus for Hernia or Nonhealing Infection

CPT-49180-PERCUTANEOUS-ABDOMINAL-NEEDLE-BIOPSY

CPT 49180: Percutaneous Abdominal Needle Biopsy

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

CPT 49185: Percutaneous Chemical Destruction of Fluid Collection

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-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

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

CPT 49255: Omentectomy for Metastatic Abdominal or Pelvic Cancer

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

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

Taxonomy Code	Specialty	Notes
`208100000X`	Pediatric Surgery	Most common specialty performing sacrococcygeal tumor excision in neonates and infants.
`2084P0202X`	Pediatric Neurosurgery	Involved when tumor extends to or near sacral neural elements.
`208000000X`	General Surgery	May perform excision in older infants or where pediatric surgery is not available.
`207RP1001X`	Pediatric Hematology‑Oncology	Consult for tumors with malignant potential; not operative but part of care team.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Q85.8`	Other phakomatoses, not elsewhere classified	Some congenital tumor syndromes can involve sacrococcygeal lesions; included when part of broader syndrome evaluation.
`D18.0`	Hemangioma and lymphangioma, any site	Vascular malformations in the sacrococcygeal region may present similarly and prompt excision.
`D49.5`	Neoplasm of uncertain behavior of other connective and soft tissue	Used when pathology initially reports uncertain behavior prior to definitive classification.
`C49.A`	Malignant neoplasm of other connective and soft tissue of trunk, except limb	Applied when the sacrococcygeal tumor is malignant soft tissue origin.
`Q76.3`	Sacral agenesis and caudal regression syndrome	Associated congenital anomalies may co‑exist; relevant for surgical planning.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`51702`	Incision and drainage, deep abscess, postsurgical wound infection of pelvic area	Used if postoperative wound infection or abscess requires drainage following sacrococcygeal tumor excision.
`88304`	Surgical pathology, gross and microscopic examination	Pathology coding for tumor specimen evaluation; assigned by pathology for diagnostic interpretation of the excised mass.
`72197`	MRI pelvis with and without contrast, infant/child when performed under anesthesia	Preoperative imaging to delineate extent of sacrococcygeal tumor and relation to pelvic structures.
`51701`	Insertion of temporary urinary catheter (if needed)	Used perioperatively for urinary drainage when tumor or surgery affects bladder emptying; may be billed when separately reportable.
`15820`	Excision, complete, tumor/cyst of trunk, subcutaneous; less than 3 cm	Smaller soft tissue excisions that might be considered for differential billing if lesion is subcutaneous and less extensive (use caution and follow coding guidance).

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