CPT 11450Surgery

Exc skn hdrdnt ax smpl/ntrm

CPT 11450 covers the surgical removal of diseased sweat glands and skin tissue in the armpit area caused by hidradenitis suppurativa, a chronic inflammatory condition that causes painful lumps and abscesses.

Showing rates for

National Average

Base Medicare rate

$415.98

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

3.22

PE RVU (NF)

8.91

MP RVU

0.73

Total RVU

12.86

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

NCCI bundling edits

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Billing tips

Verify place of service carefully - billing in office (POS 11) yields $415.98 versus $259.42 in facility (POS 22/24), a difference of $156.56 per case
Impact: Accurate POS coding ensures maximum appropriate reimbursement; incorrect POS can trigger $156.56 underpayment or RAC audit
Document the complexity level clearly (simple vs intermediate) as 11450 is specifically for simple/intermediate; extensive cases require 11451 which reimburses at $718.20 non-facility
Impact: Undercoding from 11451 to 11450 results in $302.22 loss per procedure; overcoding risks audit and recoupment
When performing bilateral procedures, append modifier 50 rather than billing twice with LT/RT to comply with NCCI edits and Medicare bilateral surgery rules
Impact: Proper bilateral coding prevents denials and ensures correct 150% payment ($623.97) versus risk of complete denial or reduced payment
Ensure ICD-10 code L73.2 (hidradenitis suppurativa) is primary diagnosis; cosmetic or non-covered diagnoses will trigger denial despite correct CPT coding
Impact: Medical necessity documentation prevents 100% denial ($415.98 loss) and supports appeal if questioned
Check NCCI edits before billing with same-day I&D codes (10060, 10061) as these typically bundle into 11450; use modifier 59 only when anatomically distinct sites are treated
Impact: Inappropriate unbundling leads to denial of secondary code payment ($150-200) and potential False Claims Act exposure
For commercial payers, verify if prior authorization is required for hidradenitis excision procedures, as many plans require pre-approval after failed conservative management

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 11450 in 2025?

The 2025 Medicare national average reimbursement for CPT 11450 is $415.98 in the non-facility (office) setting and $259.42 in the facility setting (hospital outpatient or ASC). Actual rates may vary by geographic locality based on GPCI adjustments.

What is the difference between CPT 11450 and 11451?

CPT 11450 covers simple or intermediate excision of axillary hidradenitis, while 11451 represents complex excision requiring more extensive tissue removal, often with flap or graft reconstruction. Code 11451 reimburses significantly higher ($718.20 non-facility) and should be used when extensive undermining, complex closure, or substantial tissue removal is required.

Can I bill CPT 11450 bilaterally with modifier 50?

Yes, CPT 11450 can be billed with modifier 50 when bilateral axillary excisions are performed during the same operative session. Medicare typically reimburses bilateral procedures at 150% of the unilateral rate, resulting in approximately $623.97 for bilateral treatment in the non-facility setting.

What diagnosis codes support medical necessity for CPT 11450?

The primary diagnosis supporting CPT 11450 is L73.2 (hidradenitis suppurativa). Documentation should include the Hurley stage and evidence that conservative treatments have failed. Cosmetic concerns or diagnoses like simple cysts or lipomas will not support medical necessity for this hidradenitis-specific code.

How many RVUs is CPT code 11450 worth?

CPT 11450 has a total of 12.86 RVUs, comprising 3.22 work RVUs, 8.91 non-facility practice expense RVUs (4.07 facility PE RVUs), and 0.73 malpractice RVUs. These values are from the CMS 2025 Medicare Physician Fee Schedule.

Does CPT 11450 require prior authorization from insurance?

Medicare does not typically require prior authorization for CPT 11450, but many commercial insurers do require pre-approval for hidradenitis surgical procedures. Always verify with the specific payer before scheduling surgery, as lack of authorization can result in complete claim denial even with correct coding and medical necessity.

Can I bill an E/M visit on the same day as CPT 11450?

You can bill an E/M service (99202-99215) on the same day as CPT 11450 only if the E/M represents a significant, separately identifiable service beyond the normal pre-operative evaluation for the procedure. Append modifier 25 to the E/M code and document the separate medical decision-making clearly in the record to avoid bundling denials.