Appendectomy for ruptured appendix with abscess or generalized peritonitis

CPT 44960 is the billing code for "Appendectomy for ruptured appendix with abscess or generalized peritonitis". For appendectomy when appendix is ruptured with abscess or generalized peritonitis

Medicare pays approximately $857.18 for CPT 44960 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.

CPT 44960 has a total RVU of 29.58, broken down as: Work RVU 12.80, Practice Expense RVU 15.50, and Malpractice RVU 1.28. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 44960 include: Indication for appendectomy; Operative findings including rupture; Presence of abscess or peritonitis; Drainage procedure if performed. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 44960: Includes appendectomy. Includes drainage of abscess Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 44960 include: 22 (Increased procedural services for difficult cases), 51 (Multiple procedures performed same session), 52 (Reduced services if procedure not completed). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

The typical time requirement for CPT 44960 is 75-105 minutes typical operative time. Time-based codes require documentation of the actual time spent providing the service.