CPT 10040Surgery

Acne surgery

CPT code 10040 covers acne surgery, which involves manually removing blackheads, whiteheads, and comedones from the skin using specialized tools. This is a common dermatology procedure for patients with severe acne that doesn't respond to topical treatments.

Showing rates for

National Average

Base Medicare rate

$112.57

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.91

PE RVU (NF)

2.47

MP RVU

0.1

Total RVU

3.48

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Always append modifier 25 to the E/M code when performing acne surgery during the same visit as an evaluation, and document the separate decision-making for the procedure
Impact: Prevents automatic denial of E/M service, protecting $75-200 in additional revenue per visit depending on E/M level
Bill only once per session regardless of number of lesions extracted; do not multiply units based on lesion count
Impact: Avoid claim rejection and audit risk; billing multiple units can trigger immediate denial and potential compliance review
Ensure documentation specifies 'acne surgery' or 'comedone extraction' rather than just 'skin exam' to support medical necessity
Impact: Reduces denial rate by 30-40% and supports the $112.57 non-facility payment versus no reimbursement for inadequate documentation
Verify place of service code matches actual location: POS 11 for office ($112.57) versus POS 22 for outpatient hospital ($50.46)
Impact: Incorrect POS can result in $62.11 underpayment per procedure and potential recoupment during audits
Consider separately billing for anesthesia (e.g., 17004 for destruction with anesthesia) only if extensive infiltrative anesthesia is used, not for topical application
Impact: Topical anesthesia is bundled into 10040; improper unbundling can trigger denials and compliance issues
Link to appropriate acne diagnosis codes (L70.0, L70.1, L70.8) to establish medical necessity and distinguish from cosmetic procedures
Impact: Prevents cosmetic exclusion denials; ensures payment versus $0 reimbursement for cosmetic indication

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Frequently asked questions

What is the CPT code 10040 used for?

CPT code 10040 is used for acne surgery, which involves the manual extraction of comedones (blackheads and whiteheads), pustules, and other acne lesions using specialized dermatologic instruments. It is billed once per session regardless of the number of lesions treated.

How much does Medicare pay for CPT 10040 in 2025?

Medicare pays $112.57 for CPT 10040 when performed in a non-facility setting (office) and $50.46 when performed in a facility setting (hospital outpatient department) based on the 2025 national average rates. Actual payment may vary by geographic location based on local GPCI adjustments.

Can I bill an office visit and acne surgery on the same day?

Yes, you can bill both an E/M service and CPT 10040 on the same day if the E/M represents a significant, separately identifiable service beyond the decision to perform the procedure. You must append modifier 25 to the E/M code and document the separate evaluation and management component clearly in your notes.

Is CPT 10040 billed per lesion or per session?

CPT 10040 is billed once per session, not per lesion. Whether you extract 5 comedones or 50 comedones during a single patient encounter, you report the code only once. Billing multiple units based on lesion count will result in claim denials.

What diagnosis codes support medical necessity for 10040?

Appropriate ICD-10 codes include L70.0 (acne vulgaris), L70.1 (acne conglobata), L70.8 (other acne), and L70.9 (acne unspecified). Documentation should show inflammatory acne or comedonal acne unresponsive to conservative treatment to avoid cosmetic exclusion denials.

What are the RVUs for CPT code 10040?

For 2025, CPT 10040 has a work RVU of 0.91, non-facility practice expense RVU of 2.47, facility practice expense RVU of 0.55, and malpractice RVU of 0.10, for a total non-facility RVU of 3.48. These are multiplied by the conversion factor of 32.3465 to determine Medicare payment.

Will insurance cover acne surgery or is it considered cosmetic?

Insurance will cover CPT 10040 when performed for medical treatment of acne with appropriate diagnosis coding and documentation of medical necessity. Procedures performed solely for cosmetic improvement without inflammatory disease or failed conservative therapy are typically excluded. Documentation should emphasize therapeutic intent and prior treatment attempts.