2025 CPT code 49203
(Active) Effective Date: N/A Revision Date: N/A Surgery - Excision of Intra-abdominal Tumors Surgery Feed
Open excision or destruction of one or more intra-abdominal tumors, cysts, or endometriomas (peritoneal, mesenteric, or retroperitoneal, primary or secondary); largest tumor ≤ 5 cm.
Modifiers may be applicable depending on the circumstances of the procedure.Consult the CPT manual and your payer's guidelines for details.
Medical necessity is established by the presence of symptomatic or clinically significant intra-abdominal tumors, cysts, or endometriomas requiring surgical intervention. The size of the lesion(s) and their impact on adjacent organs or structures justify the open surgical approach.
The surgeon is responsible for all aspects of the procedure, from pre-operative assessment and planning to post-operative care and follow-up. This includes making the incision, exploring the abdominal cavity, identifying and removing or destroying the tumors, controlling bleeding, and closing the incision. The surgeon may use various techniques depending on the location, type, and size of the tumors. The appropriate use of this code requires detailed documentation of the size and location of the lesions as well as the techniques and time employed.
In simple words: This code covers surgery to remove or destroy abnormal growths (tumors, cysts, or endometriomas) inside the abdomen.The largest growth must be 5 centimeters or smaller.The surgeon opens the abdomen to perform the procedure.
This CPT code encompasses the open surgical excision or destruction of one or more intra-abdominal tumors, cysts, or endometriomas located within the peritoneal, mesenteric, or retroperitoneal spaces.These lesions may be primary or secondary (metastatic). The code is specifically for cases where the largest tumor measures 5 centimeters or less in diameter. The procedure involves surgical access to the abdomen, identification and removal or destruction of the affected tissue, and closure of the surgical site.It may involve various surgical techniques depending on the location and characteristics of the lesions.
Example 1: A 55-year-old female presents with a palpable abdominal mass. Imaging reveals a 4 cm retroperitoneal cyst.Open surgical excision is performed using CPT code 49203., A 62-year-old male is diagnosed with peritoneal metastasis from a previously treated colon cancer.Multiple small lesions, the largest being 3cm, are resected using open surgery. CPT code 49203 is reported., A 30-year-old female undergoes exploratory laparotomy for suspected endometriosis. Multiple endometriomas, the largest measuring 4 cm, are found and excised.The surgeon reports CPT code 49203 for the excision.
* Operative report detailing the procedure, including incision type and location, exploration of the abdominal cavity, description of the lesions (size, number, location, type), method of excision or destruction, and closure technique.* Pre-operative and post-operative diagnoses.* Pathology report confirming the nature of the resected tissue.* Imaging studies (e.g., CT scan, MRI) demonstrating the size and location of the lesions pre-operatively.
** This code does not include the cost of any additional procedures that may be performed during the same surgical session. Such procedures would need to be reported separately with their corresponding CPT codes.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Fee schedule data varies by payer and location.Consult your payer's specific fee schedule or a commercial fee schedule database for historical information.
- Specialties:General Surgery, Gynecological Oncology, Surgical Oncology
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center