The American Medical Association (AMA) Current Procedural Terminology (CPT)* code set is updated annually. This article describes CPT 2025 coding changes that are relevant to general surgery and related specialties.
Intra-Abdominal Excision or Destruction of Tumors or Cysts
During the past 10–15 years, treatment for peritoneal surface malignancies has evolved significantly. As surgical indications, techniques, and technology have advanced, resection of significantly larger tumors and/or numerous small and large tumors is being performed to save and extend the lives of patients that were not considered candidates for treatment previously. In recognition of these changes, for CPT 2025, codes 49203, 49204, 49205 have been deleted and replaced by new codes 49186, 49187, 49188, 49189, 49190 that describe open excision or destruction of intra-abdominal primary or secondary tumor(s) or cyst(s), including cytoreduction, debulking, or other methods of removal of the tumor(s) or cyst(s). When performed via a laparoscopic or robotic approach, report the appropriate unlisted code. Table 1 (see below) provides the descriptors and Medicare Physician Fee Schedule work relative value units (RVUs) for the deleted codes 49203-49204 and the new codes 49186-49190.
Reporting is based on the sum of the maximum length of each tumor or cyst excised or destroyed (e.g., ultrasound desiccation). Only the tumor(s) and cyst(s) are measured, not the tissue (e.g., mesentery) in which the tumor(s) and cyst(s) may be implanted. If only a portion of a tumor or cyst is excised or destroyed, then only the excised or destroyed portion is measured. The tumor(s) and cyst(s) should be measured in situ before excision or destruction. It is important to document in situ measurement in the operative report. For example, “A single left retroperitoneal mass that measured 4.5 cm was identified and resected from adjacent structures with electrocautery and ultrasonic or harmonic dissectors. In addition, seven discreet 0.25 to 1.0 cm tumors in the right retroperitoneal mesentery that measured a total of 3.0 cm were identified that were then resected using electrocautery.” This example would be reported with code 49187 (sum of the maximum length of tumor(s) or cyst(s) is 5.1 to 10 cm). Note that measurement includes only the tumor(s) and cyst(s) and not the margins.
Codes 49186-49190 are reported when the resected or destroyed intra-abdominal tumor(s) and cyst(s) do not directly arise from a resected organ (e.g., small bowel mass, renal mass, liver mass) or soft tissue that may be separately reportable. When the tumors arise directly from an organ or soft tissue, only the organ or soft tissue resection or destruction procedure code from which the tumors arise is reported. For example, if a partial ascending colon resection, including small tumor implants, is performed and a separate excision of multiple small tumor implants in the mesentery of the descending colon is also performed, the appropriate colectomy code (e.g., 44140) would be reported for the partial ascending colon resection and the excision of the tumor implants in the mesentery of the descending colon would be separately reported with an appropriate tumor excision code (49186-49190). The implants that were part of the ascending colon resection would not be included in the measurement for reporting the tumor excision code (49186-49190).
Open resection of recurrent ovarian, endometrial, tubal, or primary peritoneal gynecological malignancies without lymphadenectomy may be reported with 49186-49190. All other open resection of initial or recurrent ovarian, endometrial, tubal, or primary peritoneal gynecologic malignancies should be reported with 58943, 58950, 58951, 58952, 58953, 58954, 58956, 58958, 58960. For open excision or destruction of endometriomas, use 58999.
Skin Cell Suspension Autograft
A new subsection Skin Cell Suspension Autograft (SCSA) and new codes 15011-15018 have been added to the Skin Replacement Surgery subsection of CPT. This code set will primarily be reported for burn treatment and skin trauma such as degloving. The new technology differs from other types of skin autograft (e.g., partial or full thickness) where grafts are meshed to expand 1:2. Instead, the SCSA expands 1:80, allowing for much less skin to be harvested for a much greater defect coverage.
Codes 15011 and 15012 describe the harvesting of epidermal and dermal skin for use in the autograft. Codes 15013 and 15014 describe preparation of the SCSA that requires enzymatic processing, manual mechanical disaggregation of skin cells, and filtration. If harvested skin is processed using automation rather than manual process, then it would not be appropriate to report 15013, 15014 for the autograft preparation. Codes 15015-15018 describe the spray-on application of the SCSA to the wound and donor sites. Application of the primary dressing with fixation (e.g., surgical glue, sutures, staples) is included and not reported separately. Surgical preparation of the recipient site prior to application of the SCSA, placement of a separate additional autograft prior to application of the SCSA, and repair of donor site requiring skin graft or local flaps are separately reported. For 2025, these codes are contractor priced. Table 2 (see below) provides the code descriptors and global period assigned to each code.
Synchronous Audio-Video and Audio-Only Evaluation and Management (E/M) Services
A new subsection Telemedicine Services and new codes 98000-98015 have been added to the Evaluation and Management section of CPT. These codes describe E/M services that were previously reported with the office or other outpatient E/M services codes 99202-99205 and 99211-99215, appended with modifier 95, Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System. The code descriptors and requirements for billing these codes generally mirror the existing office/outpatient E/M codes with the exception of the technological modality used to furnish the service.
The flexibility for reporting E/M services via telehealth expired at the end of 2024 and reverted back to regulations in place prior to COVID-19 waivers. Therefore, the Centers for Medicare & Medicaid Services (CMS) does not support a programmatic need to recognize the audio-video and audio-only telemedicine E/M codes for payment under Medicare. CMS has assigned a procedure status indicator of “I” meaning there is a more specific code that should be used for purposes of Medicare, which in this case would be the existing office/outpatient E/M codes currently on the Medicare telehealth services list and the appropriate place of service code to identify the location of the beneficiary. In addition, when applicable, the appropriate modifier to identify the service as being furnished via audio-only communication technology should be appended to the E/M code.
Although CMS does not recognize this set of telehealth codes, the work, practice expense, and malpractice RVUs have been published to allow reporting for non-Medicare patients when appropriate. Table 3 (see below) provides the CPT codes and descriptors for these telehealth family of codes.
Brief Virtual Check-In
CPT has established a new code for reporting a brief virtual check-in: 98016, Brief communication technology-based service (e.g., virtual check-in) by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related evaluation and management service provided within the previous 7 days nor leading to an evaluation and management service or procedure within the next 24 hours or soonest available appointment, 5-10 minutes of medical discussion. This code mirrors CMS Healthcare Common Procedure Coding System code G2012 that has been deleted.
Code 98016 is reported for established patients only. The service is patient-initiated and intended to evaluate whether a more extensive visit type is required (e.g., an office or other outpatient E/M service [99212, 99213, 99214, 99215]). Video technology is not required. Code 98016 describes a service of shorter duration than the audio-only services (98012-98015) and has other restrictions that are related to the intended use as a “virtual check-in” or triage to determine if another E/M service is necessary. When the patient-initiated check-in leads to an E/M service on the same calendar date, and when time is used to select the level of that E/M service, the time from 98016 may be added to the time of the E/M service for total time on the date of the encounter.
Category III Codes
A number of new CPT Category III codes have been established for 2025. Category III codes represent emerging technology, services, procedures, and service paradigms that allow data collection instead of reporting an unlisted code. These codes are contractor priced and may or may not be covered by Medicare and other payers. Table 4 (see below) provides the new Category III codes relevant to general surgery and related specialties.
Looking forward to CPT 2026
The meeting cycle for the CPT 2026 code set has concluded, resulting in new codes and guidelines that will be effective for CPT 2026. Several changes that are important to general surgery and related specialties include: (1) Addition of one code to report a gastric restrictive procedure through an endosurgical approach; (2) An editorial change throughout the CPT code set to delete the term “peritoneoscopy;” (3) Addition of 46 codes for reporting vascular procedures in the iliac vascular territory, femoral and popliteal vascular territory, tibial and peroneal vascular territory, and inframalleolar vascular territory, with deletion of the lower extremity revascularization codes 37220-37235; (4) Addition of two codes to report thoracic branch endograft services and revision of four current codes (33880, 33881, 33883, 33886) for repair of the thoracic aorta; (5) Addition of two codes to report rectal sensation and anorectal manometry, with deletion of 91120 and 91122; (6) Addition of two codes for reporting percutaneous irreversible electroporation ablation of tumors including imaging guidance of the liver and the prostate; and (7) Addition of eight new codes for reporting baroreflex activation therapy (BAT) modulation system procedures. Please note that codes are not assigned, nor exact wording finalized, until just prior to publication of the CPT codebook. Release of more specific CPT code set information is timed with the release of the entire set of coding changes in the CPT publication.†
Learn More
As part of the College’s ongoing efforts to help members and their practices submit clean claims and receive proper reimbursement, a coding consultation service—the ACS Coding Hotline—has been established for coding and billing questions. ACS members are offered five free consultation units (CUs) per calendar year. One CU is a period of up to 10 minutes of coding services time. Access the ACS Coding Hotline website at prsnetwork.com/acshotline.
Dr. Megan McNally is a surgical oncologist at Saint Luke’s Health System in Kansas City, Missouri, and assistant clinical professor in the Department of Surgery at the University of Missouri-Kansas City School of Medicine. She also is a member of the ACS General Surgery Coding and Reimbursement Committee and the ACS advisor to the AMA CPT Editorial Panel.
†American Medical Association. Summary of panel actions. Available at www.ama-assn.org/about/cpt-editorial-panel/summary-panel-actions. Accessed November 25, 2024.
