CurrentSelectHealthPolicy 34

Appendectomy reimbursement policy

This policy governs SelectHealth reimbursement for appendectomy procedures across Commercial, CHIP, Medicare Advantage, and Medicaid plans, specifying when appendectomy codes are payable or considered incidental.

Policy Summary

PayerSelectHealth

PolicyAppendectomy reimbursement policy

Policy CodePolicy 34

Change TypeNo material changes

Effective DateJan 1, 2023

Next Review Date

Key ActionDo not bill for incidental appendectomy when performed as part of another major abdominal procedure; document separate procedure, time, and effort if billed separately.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

44950–44979applicable CPT codes listed

Commercial/CHIP/MA/Medicaidplans governed

1/1/04implementation date

When Appendectomy is Reimbursable

Appendectomy coverage rules

Conditions under which SelectHealth will or will not reimburse appendectomy codes:

ALL of the following

When appendectomy is performed at the time of another major abdominal procedure (open 44955 or laparoscopic 44979), the removal must be clearly identifiable as a separate procedure.
The additional time and effort required to perform the appendectomy must be clearly documented in the patient record.

Standalone laparoscopic appendectomy billed with code 44979 will not be reimbursed.

Reimbursement is allowed for code 44960 when performed as a standalone and medically necessary procedure for ruptured appendix with abscess or generalized peritonitis.

Policy Summary

PayerSelectHealth

PolicyAppendectomy reimbursement policy

Policy CodePolicy 34

Change TypeNo material changes

Effective DateJan 1, 2023

Next Review Date

Key ActionDo not bill for incidental appendectomy when performed as part of another major abdominal procedure; document separate procedure, time, and effort if billed separately.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

CPT Codes and Specific Coding Rules

Covered and referenced CPT codesCPT

44950	Appendectomy
44955	Appendectomy when done for indicated purpose at the time of other major procedure
44960	Appendectomy when done for ruptured appendix with abscess or generalized peritonitis
44970	Laparoscopy surgical appendectomy
44979	Unlisted laparoscopy procedure, appendix

Stand‑alone laparoscopic appendectomy (CPT 44979) reimbursement rules

Policy on CPT 44979SelectHealth will not reimburse for an appendectomy billed as a stand-alone laparoscopic procedure when code 44979 is used.

Exception for 4497944979 may be reimbursed when the appendectomy is performed and documented as part of another major abdominal procedure (open 44955 or laparoscopic 44979) and the removal is verifiable in the patient record.

Documentation requiredWhen 44979 is allowed as part of another major procedure, the removal must be clearly identifiable as a separate procedure and additional time and effort must be clearly documented in the patient record.

Related reimbursable codesCodes 44950 and 44970 are reimbursable when performed as stand-alone and medically necessary; 44960 has its own medical-necessity exception.

Billing, Documentation, and Medical Necessity Exceptions

Billing Rule

Do not bill for incidental appendectomy; document separate procedure and extra effort if billed

Do not bill separately for an incidental appendectomy performed as part of another major abdominal (open or laparoscopic) procedure; the appendectomy is considered included in the major procedure. If reimbursement is requested for an appendectomy performed at the time of another major abdominal procedure (open 44955 or laparoscopic 44979), the removal must be clearly identifiable as a separate procedure and the additional time and effort must be documented in the patient record.

Appendectomy incidental to another abdominal procedure is included in the major procedure and not separately reimbursed.
When appendectomy is reported with another major procedure (44955 or 44979) documentation must show the removal as a separate procedure and document additional time and effort.

Prior Authorization

Reimbursement allowed for 44960 when standalone and medically necessary for rupture with abscess or peritonitis

Reimbursement for code 44960 is allowed when the appendectomy is a standalone, medically necessary procedure for a ruptured appendix with abscess or generalized peritonitis.

44960 applies to appendectomy when done for ruptured appendix with abscess or generalized peritonitis.
Ensure the record documents that the procedure was standalone and medically necessary for the indicated condition.

Key Terms

Appendectomy — definition

DefinitionAn appendectomy is the removal by surgery (open or laparoscopic) of the appendix, usually performed because of probable appendicitis.

Typical indicationPerformed for probable appendicitis, an inflammation of the appendix often associated with infection.

Surgical approachesMay be performed as an open procedure or via laparoscopy.

Incidental appendectomy — definition

DefinitionAn incidental appendectomy is the removal of the appendix that is incidental to another abdominal (open or laparoscopic) procedure and is considered included in the major procedure for reimbursement purposes.

Reimbursement stanceSelectHealth will not reimburse separately for an incidental appendectomy; it is included in the payment for the major abdominal procedure.

Documentation guidanceIf performed at the time of another major abdominal procedure, the appendix removal must be clearly identifiable and any additional time and effort should be documented if reimbursement is considered under review.