🧬 CPT 41130: Glossectomy; Hemiglossectomy

📋 Code Information

Field	Value
CPT Code	41130
Descriptor	Glossectomy; hemiglossectomy
Section	Excision Procedures on the Tongue and Floor of Mouth (41100-41155)
Approach	Open surgical
Global Period	90 days (Major Surgery)
Effective Date	Pre-1990 (legacy code)
Last Updated	2026-01-01 (no change from 2025)

📖 Clinical Description

CPT 41130 describes a hemiglossectomy — the surgical removal of one lateral half of the tongue. The surgeon excises approximately half of the tongue, typically including the lateral border, the dorsal and ventral surfaces of the affected hemi-tongue, and extends to the midline. This is most commonly performed for malignant neoplasms of the tongue (squamous cell carcinoma), though it may also be indicated for severe benign conditions or trauma.^[1][7][10]

Anatomical Definition

The mobile tongue (anterior two-thirds) consists of:

Dorsal surface — top of the tongue with taste buds
Ventral surface — undersurface of the tongue
Lateral borders — sides of the tongue, the most common site for squamous cell carcinoma
Tip (apex) — the most anterior point

The base of tongue (posterior one-third) is a fixed structure; tumors here may require additional procedures beyond 41130.

Critical Distinction: 41130 specifically denotes removal of one lateral half (hemi) of the tongue. Removal of less than one-half is coded 41120. When hemiglossectomy is combined with a unilateral radical neck dissection, use 41135 instead.^[8][9]

Procedure Steps

Anesthesia: General anesthesia is administered; often with nasal or oral intubation or tracheostomy depending on tumor extent.
Access: Intraoral approach for smaller resections; may require mandibulotomy or transcervical approach for larger tumors.
Resection: The surgeon marks the midline and lateral margins with appropriate oncologic margins (typically ≥1 cm). The hemi-tongue is excised through the tongue musculature to the midline.
Hemostasis: Achieved with electrocautery, suture ligation, or vessel clips.
Reconstruction: Primary closure for smaller defects; local flaps, regional flaps (e.g., submental island flap), or free flaps (e.g., radial forearm free flap) may be utilized for larger defects.
Closure: Multilayer closure with absorbable sutures.

Indications

Squamous cell carcinoma of the lateral tongue (most common)
Other malignant neoplasms of the tongue (adenocarcinoma, mucoepidermoid carcinoma)
Severe benign tumors not amenable to lesser resection
Severe chronic infection or necrosis of the tongue
Significant traumatic injury requiring partial tongue amputation

🔍 Includes and Inclusions

Surgical removal of one lateral half of the tongue^[1][7]
Hemostasis and wound closure (primary or flap)^[1]
All pre-operative and post-operative care within the 90-day global period^[3]
One pre-operative day included in the global period^[3]

🚫 Excludes and Differentiating Codes

Glossectomy Code Selection

Code	Description	When to Use
41120	Glossectomy; less than one-half tongue	When less than half the tongue is removed
41130	Glossectomy; hemiglossectomy	When exactly/approximately half (one lateral half) is removed — THIS CODE
41135	Glossectomy; partial, with unilateral radical neck dissection	Hemiglossectomy combined with radical neck dissection
41140	Glossectomy; complete or total, without radical neck dissection	Total tongue removal without neck dissection
41145	Glossectomy; complete or total, with unilateral radical neck dissection	Total tongue removal with neck dissection
41150	Composite: glossectomy + floor of mouth resection + mandibular resection, without RND	Complex composite resection
41153	Composite: glossectomy + floor of mouth + suprahyoid neck dissection	Extended composite procedure
41155	Composite: glossectomy + floor of mouth + mandibular resection + radical neck dissection	Most extensive composite

Lesion Excision vs. Glossectomy

⚠️ Critical Coding Rule: Glossectomy codes (41120-41155) require removal of a portion of the tongue itself, not just a lesion. If only a lesion is excised, use 41110-41114.

Scenario	Correct Code
Excision of tongue lesion, no closure	41110
Excision of tongue lesion with closure, anterior 2/3	41112
Excision of tongue lesion with closure, posterior 1/3	41113
Excision of tongue lesion with local tongue flap	41114
Removal of less than half of tongue tissue	41120
Removal of one lateral half of tongue	41130

Procedures Not Reported Separately with 41130

Code	Description	Rationale
41135	Glossectomy with radical neck dissection	If neck dissection is performed, upgrade to 41135 — do not report 41130 + neck dissection separately
Routine hemostasis	Included	Part of the surgical package
Post-op visits within 90 days	Included	Part of 90-day global period

📊 Code Tree and Hierarchy

flowchart TD
    A["41100-41155 Excision Procedures on the Tongue and Floor of Mouth"] --> B["Lesion Excision Codes"]
    B --> C["41110 Excision of lesion; without closure"]
    B --> D["41112 Excision of lesion; with closure, anterior 2/3"]
    B --> E["41113 Excision of lesion; posterior 1/3"]
    B --> F["41114 Excision of lesion; with local tongue flap"]

    A --> G["Glossectomy — Partial"]
    G --> H["41120 Glossectomy; less than one-half tongue"]
    G --> I["41130 GLOSSECTOMY; HEMIGLOSSECTOMY"]
    G --> J["41135 Partial, with unilateral radical neck dissection"]

    A --> K["Glossectomy — Complete"]
    K --> L["41140 Complete or total; without RND"]
    K --> M["41145 Complete or total; with unilateral RND"]

    A --> N["Composite Procedures"]
    N --> O["41150 + floor of mouth + mandible; without RND"]
    N --> P["41153 + floor of mouth; with suprahyoid neck dissection"]
    N --> Q["41155 + floor of mouth + mandible + RND"]

    style I fill:#4169E1,stroke:#333,stroke-width:2px,color:white

🔄 Modifiers and Billing Nuances

Applicable Modifiers for 41130

Modifier	Description	Application
-22	Increased Procedural Services	Use when work is substantially greater than typical (e.g., extensive reconstruction, significant bleeding, re-operative field)
-51	Multiple Procedures	Use when multiple procedures are performed in same session; Medicare applies automatically
-52	Reduced Services	Use when procedure is partially reduced at the physician’s discretion
-54	Surgical Care Only	Use when surgeon provides surgical care but transfers post-op care to another provider
-55	Postoperative Management Only	Use when provider accepts post-op care from surgeon who used modifier 54
-56	Preoperative Management Only	Use when pre-op care only is provided
-57	Decision for Surgery	Append to the E/M code on the day of or day before major surgery when E/M results in decision for surgery
-58	Staged or Related Procedure	Use for staged procedures, more extensive than original, or therapy following diagnostic procedure during post-op period
-59	Distinct Procedural Service	Use to indicate a procedure is distinct/independent from other services performed same day
-76	Repeat Procedure, Same Physician	Use if procedure is repeated on the same day by the same physician
-77	Repeat Procedure, Another Physician	Use if repeated by a different physician on the same day
-78	Unplanned Return to OR — Related Procedure	Use for related procedure performed during the post-op period
-79	Unrelated Procedure During Post-op Period	Use for unrelated procedure during the 90-day global period

Assistant Surgeon Modifiers for 41130

Modifier	Description	Application
-80	Assistant Surgeon	Physician assistant at surgery — generally payable for this major procedure
-81	Minimum Assistant Surgeon	Minimal assistance during a portion of surgery
-82	Assistant Surgeon (resident not available)	Teaching hospital setting when qualified resident is unavailable
[-[AS]]	Non-Physician Assistant at Surgery	PA, NP, RNFA, CNS assisting

Important Modifier Notes

Modifier -57 with E/M: Because 41130 has a 90-day global period, an E/M performed on the day of or the day before surgery that results in the initial decision to perform surgery should be appended with modifier -57.^[3]
Modifier -22 for reconstruction: If the hemiglossectomy requires a complex free flap reconstruction (e.g., radial forearm free flap — see 15757/15758), document the significantly increased work; however, the free flap codes may be separately reportable — do not double-dip with modifier -22 and a separate flap code.^[1]
Neck Dissection Bundling: If a radical neck dissection is performed simultaneously, do not report 41130 + a neck dissection code. Instead, report 41135 (which includes the neck dissection). If a modified radical neck dissection is performed, check NCCI edits — 38724 may be separately reportable with modifier -59.^[8][9]

👨‍⚕️ Assistant Surgeon (Modifier -80) Payability

Assistant Surgeon Information

For a major procedure like 41130, an assistant surgeon is commonly medically necessary, particularly when reconstruction is performed or when the operative field is complex.

Medicare Payment Indicators

To confirm assistant surgeon payability for 41130, check the Medicare Physician Fee Schedule Database (MPFSDB) “Asst Surg” indicator:

Indicator	Meaning
0	Payment restriction; supporting documentation required
1	Statutory payment restriction; assistants not paid
2	Payment restriction does NOT apply; assistants may be paid
9	Concept does not apply

✅ Clinical Reality: Given the complexity of hemiglossectomy — especially with reconstruction — assistant surgeon services are commonly billed and reimbursed for 41130. Always verify current MPFSDB indicator and consult your MAC LCD.

Documentation for Teaching Hospitals

If the indicator is 0 or 1, documentation must reflect:

No qualified resident was available, OR
Exceptional medical circumstances existed, OR
Primary surgeon has an across-the-board policy of not involving residents

💰 Work RVU (wRVU) and Reimbursement

Work RVU Information

The Work Relative Value Units (wRVU) for 41130 are updated annually by CMS. For current 2026 values:

2026 Reference: Consult the CMS MPFS RVU26A file or the AMA RBRVS DataManager^[2][4]
2026 Efficiency Adjustment: CMS finalized a -2.5% efficiency adjustment to wRVUs and intra-service times for nearly all non-time-based codes, including surgical procedures like 41130^[4][5]

2026 Medicare Payment Updates

Factor	Value
Conversion Factor (non-QP/non-APM)	$33.4009
Conversion Factor (QP/APM)	$33.5675
Efficiency Adjustment	-2.5% applied to wRVUs for non-time-based surgical codes including 41130
Global Period	90 days (Major Surgery) — one pre-op day + surgery day + 90 post-op days included

Note: The 2026 wRVU for 41130 will be slightly lower than 2025 due to the CMS efficiency adjustment. Always pull the current value directly from CMS RVU26A or your contracting system before finalizing compensation calculations.^[4][5]

National Average Reimbursement

National average reimbursement for CPT 41130 ranges approximately $1, 564 -$ 2,150 depending on payer, though this varies significantly by MAC region, payer contract, and setting (facility vs. non-facility). Consult payer-specific fee schedules for accurate values.

📋 Documentation Requirements

To support billing of 41130, the operative report must clearly document:^[1][7][8]

Preoperative Diagnosis: Specific indication (e.g., “squamous cell carcinoma, right lateral tongue, T2N0M0”)
Extent of Resection: Explicit statement that one lateral half of the tongue was removed (distinguishes from 41120)
Margins: Intraoperative margin documentation (e.g., “all margins negative at frozen section”)
Reconstruction Method: Primary closure vs. flap type if applicable
Anatomical Boundaries: Medial extent (midline), anterior/posterior extent, and depth
Laterality: Specify right or left hemiglossectomy
Pathology Submission: Specimen sent to pathology for permanent section

Critical Documentation Elements

Element	Why It Matters
”Hemiglossectomy” or “lateral half”	Distinguishes 41130 from 41120 (less than half)
Absence of neck dissection	Confirms 41130 is correct; if RND present, use 41135
Reconstruction documentation	If free flap used, separate CPT codes may be additionally reportable
Laterality	Right vs. left; required for complete coding and clinical record

📊 ICD-10 Crosswalk and HCC Information

Primary ICD-10 Diagnoses for 41130

ICD-10 Code	Description	HCC Applicability
C02.1	Malignant neoplasm of border of tongue	Yes (HCC 8 or 10)
C02.0	Malignant neoplasm of dorsal surface of tongue	Yes (HCC 8 or 10)
C02.2	Malignant neoplasm of ventral surface of tongue	Yes (HCC 8 or 10)
C02.3	Malignant neoplasm of anterior 2/3 of tongue, NOS	Yes (HCC 8 or 10)
C02.8	Malignant neoplasm of overlapping sites of tongue	Yes (HCC 8 or 10)
C02.9	Malignant neoplasm of tongue, unspecified	Yes (HCC 8 or 10)
C01	Malignant neoplasm of base of tongue	Yes (HCC 8 or 10)
C06.9	Malignant neoplasm of mouth, unspecified	Yes (HCC 8 or 10)
D10.1	Benign neoplasm of tongue	No (0)
K14.0	Glossitis	No (0)
K14.8	Other specified conditions of tongue	No (0)
S09.93XA	Unspecified injury of face, initial encounter (trauma indication)	No (0)
Z85.818	Personal history of malignant neoplasm of other digestive organs	No (0)

HCC Note

Malignant neoplasms of the tongue (C01, C02.x) are significant risk adjusters, mapping to HCC 8 or 10 depending on the CMS-HCC model version used
Benign and inflammatory conditions (D10.1, K14.x) do not contribute to HCC risk scores
The CPT procedure code 41130 itself is not an HCC contributor — diagnosis codes drive risk adjustment

🏥 MS-DRG Assignment

When 41130 is performed in an inpatient setting, it typically maps to the following MS-DRGs:^[6]

For Malignant Tongue Diagnoses (e.g., C02.1)

MS-DRG	Description
146	Ear, nose, mouth and throat malignancy with MCC
147	Ear, nose, mouth and throat malignancy with CC
148	Ear, nose, mouth and throat malignancy without CC/MCC

For Mouth/Tongue Surgical Procedures

MS-DRG	Description
137	Mouth procedures with CC/MCC
138	Mouth procedures without CC/MCC

ICD-10-PCS Procedure Codes

For hospital inpatient coding, hemiglossectomy is reported with ICD-10-PCS codes:

Approach	ICD-10-PCS Code	Description
Open	0CB70ZZ	Excision of Tongue, Open Approach
Open, Diagnostic	0CB70ZX	Excision of Tongue, Open Approach, Diagnostic
Endoscopic (via natural orifice)	0CB78ZZ	Excision of Tongue, Via Natural or Artificial Opening Endoscopic

⚠️ For inpatient profee coding, the CPT code 41130 is used on the professional claim; ICD-10-PCS is used on the facility (UB-04) claim only.

📝 Coding Examples and Scenarios

Example 1: Standard Hemiglossectomy for SCC

Scenario: A 62-year-old male with biopsy-proven squamous cell carcinoma of the right lateral tongue, clinical T2N0M0. The head and neck surgeon performs a right hemiglossectomy via an intraoral approach with primary closure. No neck dissection performed. Coding:

41130 — Glossectomy; hemiglossectomy
C02.1 — Malignant neoplasm of border of tongue
Rationale: Removal of the right lateral half of the tongue without neck dissection = 41130. Document “hemiglossectomy” explicitly in the operative report.^[1][8]

Example 2: Hemiglossectomy WITH Radical Neck Dissection — Wrong Code Trap

Scenario: Same patient as above, but intraoperative findings reveal a suspicious lymph node; surgeon performs a right hemiglossectomy AND a right radical neck dissection. Coding:

Correct: 41135 — Glossectomy; partial, with unilateral radical neck dissection
Incorrect: 41130 + 38720 or 38724
Rationale: When a hemiglossectomy (or partial glossectomy) is combined with a radical neck dissection, the combined procedure is captured entirely by 41135. Do NOT separately report 41130 and a neck dissection code.^[8][9]

Example 3: Hemiglossectomy with Free Flap Reconstruction

Scenario: A 55-year-old female undergoes right hemiglossectomy with immediate reconstruction using a radial forearm free flap. Coding:

41130 — Glossectomy; hemiglossectomy
15757 or 15758 — Free skin flap with microvascular anastomosis (depending on flap type)
C02.1 — Malignant neoplasm of border of tongue
Rationale: The free flap reconstruction is separately reportable from the glossectomy. Check NCCI edits and verify payability with your specific payer.^[1]

Example 4: Less Than Half — Wrong Code Trap

Scenario: A surgeon removes a 2 cm wedge of the lateral tongue that does not extend to the midline. The op report states “partial glossectomy.” Coding:

Correct: 41120 — Glossectomy; less than one-half tongue
Incorrect: 41130
Rationale: If the resection does not extend to and include one full lateral half (hemi), use 41120. The distinction hinges on extent of resection documented in the op note.^[8][9]

Example 5: Decision for Surgery E/M on Same Day

Scenario: A new patient presents to the head and neck surgeon for evaluation of a tongue mass. The surgeon performs a detailed history and physical, reviews imaging, and determines the patient requires a hemiglossectomy scheduled the same day as an urgent procedure. Coding:

Appropriate E/M code (e.g., 99205 or 99243) — -57
41130 — Glossectomy; hemiglossectomy
Rationale: Modifier -57 appended to the E/M indicates it was the decision for a major surgery (90-day global). Without modifier -57, the E/M on the day of a major surgery is bundled into the global package.^[3]

⚠️ Important Coding Notes

The Key Distinction: 41120 vs. 41130

Code	Amount Removed	Documentation Needed
41120	Less than one-half tongue	”Partial glossectomy,” “wedge resection,” extent < 50%
41130	One lateral half (hemi)	“Hemiglossectomy,” “right/left hemi-tongue,” extent ≈ 50%

Neck Dissection Bundling Alert

⚠️ Do NOT unbundle 41130 + a neck dissection code. The neck dissection “upgrades” the code to 41135, 41145, 41153, or 41155 depending on the composite procedure performed.

Global Period — 90 Days

41130 carries a 90-day global period
Includes: 1 pre-op day, day of surgery, 90 post-op days
Separately reportable during the global period: unrelated procedures (modifier -79), staged procedures (modifier -58), return to OR for complications (modifier -78)
E/M on day of surgery: NOT separately payable unless modifier -57 (decision for surgery) applies

2026 Efficiency Adjustment Impact

The -2.5% CMS efficiency adjustment reduces the wRVU for 41130 compared to 2025. Organizations using wRVU-based physician compensation should audit their compensation models to account for this structural change.

Glossectomy Family

Code	Description
41120	Glossectomy; less than one-half tongue
41135	Glossectomy; partial, with unilateral radical neck dissection
41140	Glossectomy; complete or total, without radical neck dissection
41145	Glossectomy; complete or total, with unilateral radical neck dissection
41150	Composite; glossectomy + floor of mouth + mandibular resection, without RND
41153	Composite; glossectomy + floor of mouth, with suprahyoid neck dissection
41155	Composite; glossectomy + floor of mouth + mandibular resection + radical neck dissection

Tongue Lesion Excision Codes

Code	Description
41110	Excision of lesion of tongue without closure
41112	Excision of lesion of tongue with closure; anterior two-thirds
41113	Excision of lesion of tongue with closure; posterior one-third
41114	Excision of lesion of tongue with closure; with local tongue flap

Code	Description
38700	Suprahyoid lymphadenectomy
38720	Cervical lymphadenectomy (complete)
38724	Cervical lymphadenectomy (modified radical neck dissection)

Reconstruction Codes

Code	Description
15757	Free skin flap with microvascular anastomosis
15758	Free fascial flap with microvascular anastomosis
15731	Forehead flap with preservation of vascular pedicle

References

[¹ MD Clarity. “CPT Code 41130: What It Is, Modifiers, Reimbursement.” (2024). https://www.mdclarity.com/cpt-code/41130 ² CMS. “Calendar Year 2026 Medicare Physician Fee Schedule Final Rule (CMS-1832-F).” (2025). https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f ³ CMS. “MLN907166 - Global Surgery Booklet.” https://www.cms.gov/files/document/mln907166-global-surgery-booklet.pdf ⁴ PYA. “2026 wRVU Changes and Physician Compensation Planning.” (2026). https://www.pyapc.com/insights/2026-wrvu-changes-are-here-what-organizations-need-to-know-for-physician-compensation-planning/ ⁵ MedAxiom. “CMS Releases 2026 Final Physician Fee Schedule Rule.” (2025). https://www.medaxiom.com/news/2025/11/05/news/cms-releases-2026-final-physician-fee-schedule-rule/ ⁶ CodingBillingSolutions. “Oral Cancer ICD-10 Codes.” (2024). https://codingbillingsolutions.com/blogs/oral-cancer-icd-10-codes/ ⁷ GenHealth.ai. “41130 - Glossectomy; hemiglossectomy.” (2026). https://genhealth.ai/code/cpt4/41130-glossectomy-hemiglossectomy ⁸ AAPC Otolaryngology Coding Alert. “CPT Coding Strategies for Glossectomy Reporting.” https://www.aapc.com/codes/scc_articles/article_pdf/94/cpt-coding-strategies-perfect-glossectomy-reporting-using-this-expert-adv ⁹ KZA Coding Coaches. “Glossectomy Coding Help.” (2023). https://www.kzanow.com/coding-coaches/glossectomy-coding-help ¹⁰ AAPC. “CPT Code 41130 - Excision Procedures on the Tongue and Floor of Mouth.” (2026). https://www.aapc.com/codes/cpt-codes/41130 ¹¹ PayerPrice. “CPT Code 41130 - Description and Fee Schedule 2026.” (2025). https://payerprice.com/rates/41130-CPT-fee-schedule]

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