Sistrunk Procedure CPT 60281 Reimbursement | OpenPayer

Summary & Overview

CPT 60281: Sistrunk Procedure for Thyroglossal Duct Cyst Excision

CPT code 60281 represents the Sistrunk procedure — the complete surgical removal of a thyroglossal duct cyst or sinus with excision of a portion of the hyoid bone and tract up to the tongue base. This definitive operation matters nationally because it reduces recurrence risk for a common congenital neck lesion and involves inpatient or ambulatory surgical resources, impacting surgical utilization and facility mix. Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, common sites of service, and the implications for billing and claims processing. The publication also summarizes benchmarking considerations across major payers, common modifier usage patterns (listed separately), and policy-related factors that affect coverage and prior authorization. Clinical context covers indications for the Sistrunk procedure, factors that increase recurrence risk, and typical perioperative resource needs. Policy and billing sections review payer approaches to surgical coding and facility billing lines, and identify where data is not available in the input. This national overview is intended for coding professionals, surgical administrators, and policy analysts seeking a clear, pragmatic summary of CPT code 60281 and its operational implications.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare60281CPTSistrunkthyroglossal-duct-cysthead-and-neck-surgeryotolaryngologyambulatory-surgerysurgical-procedure

Billing Code Overview

CPT code 60281 describes the complete surgical removal of a thyroglossal duct cyst or sinus, commonly known as the Sistrunk procedure. The operation includes excision of the entire cyst or sinus tract up to the base of the tongue and removal of a portion of the hyoid bone to reduce recurrence risk.

Service type: Surgical, otolaryngology/head and neck procedure

Typical site of service: Hospital operating room or ambulatory surgery center

Clinical & Coding Specifications

Clinical Context

A typical patient is a pediatric or young adult presenting with a midline neck mass that moves with tongue protrusion or swallowing, often tender or with recurrent infections. The clinician evaluates history, physical exam, and orders ultrasound of the neck; if infected, antibiotics and possible drainage are given before definitive surgery. The patient is scheduled for a Sistrunk procedure (60281) performed under general anesthesia in an outpatient ambulatory surgery center or hospital operating room. The surgeon makes a transverse cervical incision, excises the thyroglossal duct cyst or sinus tract completely up to the foramen cecum at the base of the tongue, and removes the central portion of the hyoid bone to reduce recurrence. Specimens are sent to pathology. Typical perioperative workflow includes preoperative anesthesia assessment, intraoperative airway management, operative reporting, postoperative recovery in PACU, and discharge with wound care instructions and follow-up for suture removal and pathology review.

Coding Specifications

Modifier	Description	When to Use
`00`	Default or unspecified — normally not appended	Not used; appears in raw list as a placeholder but not applied clinically
`11`

Related Codes

CPT-60225-NEAR-TOTAL-THYROIDECTOMY

CPT 60225: Near-Total Thyroidectomy

CPT-60254-TOTAL-OR-NEAR-TOTAL-THYROIDECTOMY-WITH-NECK-DISSECTION

CPT 60254: Total or Near-Total Thyroidectomy with Neck Dissection

CPT-60212-PARTIAL-THYROIDECTOMY-ISTHMUSECTOMY

CPT 60212: Partial Thyroidectomy with Isthmusectomy

CPT-60100-THYROID-CORE-NEEDLE-BIOPSY-IMAGE-GUIDED

CPT 60100: Image-Guided Thyroid Core Needle Biopsy

CPT-60252-TOTAL-OR-SUBTOTAL-THYROIDECTOMY-LIMITED-NECK-DISSECTION

CPT 60252: Total or Subtotal Thyroidectomy with Limited Neck Dissection

CPT-60260-COMPLETION-THYROIDECTOMY-REMOVAL-REMAINING-THYROID

CPT 60260: Completion Thyroidectomy, Removal of Remaining Thyroid

CPT-60240-TOTAL-THYROIDECTOMY

CPT 60240: Total Thyroidectomy

CPT-60210-THYROID-PARTIAL-LOBECTOMY-ISTHMUS-OPTIONAL

CPT 60210: Partial Thyroid Lobectomy, Isthmus Optional

CPT-60271-THYROIDECTOMY-SUBSTERNAL-EXTENSION

CPT 60271: Thyroidectomy with Substernal Extension

CPT-60200-THYROID-NODULE-EXCISION-OR-ISTHMUSECTOMY

CPT 60200: Removal of Thyroid Cyst or Incision of Thyroid Isthmus

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Taxonomy Code	Specialty	Notes
`208600000X`	Otolaryngology (ENT)	Most common specialty performing Sistrunk procedures
`207L00000X`	Pediatric Surgery	Performs Sistrunk for pediatric patients, often in tertiary centers
`208000000X`	General Surgery	May perform procedure when ENT is not available, especially in adults
`207R00000X`	Pediatric Otolaryngology	Subspecialty focus for complex pediatric airway and neck anomalies
`363A00000X`	Plastic and Reconstructive Surgery	In select cases where cosmetic or complex reconstructive closure is required

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Q89.1`	Congenital malformation syndromes involving the head and neck	Includes congenital midline anomalies such as developmental remnants relevant to thyroglossal anomalies
`K09.8`	Other cysts of oral soft tissues	Sometimes used for cystic lesions near the tongue base when more specific codes are not applicable
`J36`	Peritonsillar abscess	Can be part of differential diagnosis for oropharyngeal infection presenting with neck mass; may coexist or complicate airway management
`L02.91`	Cutaneous abscess, unspecified site	Used when the thyroglossal cyst is acutely infected and drained prior to definitive surgery
`R22.1`	Localized swelling, mass and lump, neck	Symptom code often used at presentation for a midline neck mass prior to definitive diagnosis
`D18.0`	Hemangioma, any site	Included in differential diagnoses for pediatric neck masses that may need to be distinguished from thyroglossal duct cyst
`R07.0`	Pain in throat	Symptom code that may accompany infected or inflamed thyroglossal cysts

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`10060`	Incision and drainage of abscess; simple or single	May be performed preoperatively if the thyroglossal duct cyst is acutely infected and requires drainage before definitive `60281`
`10160`	Puncture aspiration of abscess; complicated or recurrent	Alternative or temporizing procedure for infected cysts prior to definitive excision
`20926`	Removal of foreign body, soft tissue of neck; complicated	May be required if concurrent removal of retained infected material or complex neck dissection is necessary during `60281`
`88305`	Level IV surgical pathology, gross and microscopic examination	Commonly billed for the pathologic examination of the excised thyroglossal duct cyst specimen after `60281`
`99140`	Anesthesia for emergency airway management	May be reported if unplanned airway intervention is required during or after the procedure