CPT 10061Surgery

I&d abscess comp/multiple

CPT code 10061 covers the incision and drainage (I&D) of a complicated abscess or multiple abscesses. This involves making an incision to drain infected fluid from a complex abscess pocket or treating multiple abscesses during the same session.

Showing rates for

National Average

Base Medicare rate

$208.31

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

2.45

PE RVU (NF)

3.69

MP RVU

0.3

Total RVU

6.44

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

NCCI bundling edits

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Billing tips

Document complexity factors explicitly: describe multiple loculations, depth of dissection, need for drain placement, or number of separate abscesses drained to justify 10061 over simple I&D code 10060
Impact: Prevents downcoding from 10061 ($208.31) to 10060 ($129.84), protecting $78.47 per claim in non-facility settings
Bill modifier 25 with E/M when documentation supports a significant, separately identifiable evaluation beyond the decision for I&D (e.g., evaluation of systemic symptoms, assessment of diabetes control, workup of recurrent infections)
Impact: Captures additional $100-$200 in reimbursement for appropriately documented E/M services; highest scrutiny modifier so ensure clear documentation of separate service
For multiple abscesses at different anatomic sites, bill 10061 for the first/most complex, then 10061 with modifier 59 for additional sites rather than using add-on codes
Impact: Second procedure typically reimburses at 50% ($104.16), compared to potential denial if bundling rules are triggered without modifier 59
Verify facility vs. non-facility status before billing: same-day surgery centers and hospital outpatient departments use facility rates ($179.85), while office-based procedures use non-facility rates ($208.31)
Impact: Billing incorrect place of service can result in $28.46 underpayment or overpayment that may trigger recoupment
Document medical necessity for complicated approach: postoperative wound infections, immunocompromised status, MRSA infection, or failed simple drainage attempts justify the higher-level code
Impact: Reduces audit risk and supports the 6.44 total RVUs assigned to this procedure versus 4.02 RVUs for simple I&D

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Frequently asked questions

What is the difference between CPT 10060 and 10061?

CPT 10060 is for simple or single abscess drainage, while 10061 is for complicated abscesses or multiple abscesses. Complicated factors include postoperative wounds, extensive undermining, multiple loculations requiring exploration, placement of drains, or draining multiple separate abscesses in one session. 10061 reimburses at $208.31 (non-facility) compared to $129.84 for 10060, reflecting the increased work and complexity (6.44 vs 4.02 total RVUs).

How much does Medicare pay for CPT code 10061 in 2025?

Medicare pays $208.31 for CPT 10061 in non-facility settings (office, clinic) and $179.85 in facility settings (hospital outpatient, ASC) based on the 2025 national average rates. Actual reimbursement varies by geographic location due to GPCI adjustments and by payer. The code has 6.44 total RVUs with a work RVU of 2.45.

Can you bill an E/M with CPT 10061 on the same day?

Yes, you can bill an E/M service with 10061 using modifier 25, but only if the E/M represents a significant, separately identifiable service beyond the decision to perform the I&D. Documentation must clearly show history, exam, and medical decision-making that goes beyond the procedure itself, such as evaluating systemic illness, managing comorbidities, or addressing unrelated conditions. This is heavily audited, so documentation quality is critical.

How many times can you bill CPT 10061 on the same day?

You can bill 10061 multiple times on the same day if draining multiple abscesses at distinct anatomic sites. The second and subsequent procedures should include modifier 59 or anatomic modifiers (LT/RT, FA-F9) to indicate separate sites and prevent bundling denials. The second procedure typically reimburses at 50% of the primary procedure rate. Clear documentation of each separate abscess location and complexity is essential.

What diagnosis codes support medical necessity for CPT 10061?

Common ICD-10 codes supporting 10061 include L02.xx (cutaneous abscess at various sites), L03.xx (cellulitis), T81.4 (infection following a procedure), and site-specific abscess codes. The diagnosis must match the procedure location and support the complexity or multiplicity of abscesses. For multiple abscesses, ensure all relevant diagnosis codes are listed. Recurrent abscess codes or codes indicating immunocompromised status strengthen documentation of complexity.

Does CPT 10061 include wound packing and follow-up care?

Yes, CPT 10061 includes initial wound packing, application of dressings, and routine postoperative care within the global period (10 days for minor procedures). Packing materials, local anesthesia, and standard dressings are not separately billable. Follow-up visits for routine wound checks, packing changes, or drain removal within the global period are included. Only separately identifiable complications or unrelated problems during follow-up can be billed separately with modifier 24.

What modifiers are most commonly used with CPT 10061?

The most common modifiers for 10061 are: modifier 25 (separately identifiable E/M service), modifier 59 (distinct procedural service for multiple sites), modifiers LT/RT (left/right side), modifier 78 (return to OR during global period), and modifier 79 (unrelated procedure during global period). Modifier 25 is the most frequently used but also most audited. Proper modifier use is essential to prevent denials and ensure appropriate reimbursement for complex cases.