CPT 11451Surgery

Exc skn hdrdnt ax complex

CPT code 11451 covers the surgical removal of complex hidradenitis (infected, inflamed sweat glands) in the armpit area. This procedure involves removing diseased skin and deeper tissue that has become severely infected or scarred.

Showing rates for

National Average

Base Medicare rate

$510.75

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

4.43

PE RVU (NF)

10.41

MP RVU

0.95

Total RVU

15.79

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

NCCI bundling edits

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Billing tips

Document complexity factors explicitly: number of sinus tracts, depth of involvement, extent of undermining, presence of scarring, and size of excision to justify 11451 versus simpler codes 10060-10061
Impact: Prevents downcoding to simple I&D codes which pay only $116-$242, protecting $268.75-$394.75 per case
Bill in non-facility setting when appropriate (office-based surgery suite with proper accreditation) to capture the higher non-facility rate
Impact: Increases reimbursement by $182.76 per procedure ($510.75 vs $327.99)
Use modifier 50 for bilateral procedures performed in same session rather than billing 11451 twice with LT/RT modifiers
Impact: Ensures proper 150% payment ($766.13) instead of risk of second side being denied or paid at 50% ($638.56 vs $766.13)
Separately bill for complex closure or skin grafting (13100-13102, 15100-15101) when performed, as these are not included in the excision
Impact: Additional $200-$800+ in legitimate reimbursement depending on closure complexity and size
Link to appropriate ICD-10 codes (L73.2 for hidradenitis suppurativa, specific to axilla location) and document chronicity and failure of conservative treatment
Impact: Prevents medical necessity denials that would result in $0 payment and patient balance billing issues
For planned staged procedures, use modifier 58 on subsequent excisions and document the staged plan in the initial operative note
Impact: Secures full payment for each stage rather than being subject to global period bundling (protects full $510.75 per stage)

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Frequently asked questions

What is the Medicare payment for CPT code 11451 in 2025?

The 2025 Medicare national average payment is $510.75 in non-facility settings (physician office) and $327.99 in facility settings (hospital or ASC). Actual payment varies by geographic locality based on the GPCI adjustments for your area.

What is the difference between CPT 11451 and simple hidradenitis drainage codes?

CPT 11451 is for complex excision of hidradenitis involving removal of skin and subcutaneous tissue with layered closure, while simple I&D codes (10060/10061) are for drainage only. Code 11451 requires documentation of extensive disease with sinus tracts, scarring, and definitive surgical excision rather than just abscess drainage.

Can CPT 11451 be billed bilaterally?

Yes, when both axillae are excised during the same operative session, use modifier 50 for bilateral procedure. This results in 150% payment ($766.13 non-facility) rather than billing each side separately. Documentation must clearly describe the procedure performed on each side.

What RVU value does CPT 11451 have?

CPT 11451 has a total RVU of 15.79 for 2025, consisting of 4.43 work RVUs, 10.41 non-facility practice expense RVUs (4.76 facility PE RVUs), and 0.95 malpractice RVUs. This relatively high RVU reflects the complexity and time required for the procedure.

What documentation is needed to justify CPT 11451 versus simpler excision codes?

Documentation must include specific complexity factors: presence of multiple sinus tracts, extent of scarring and fibrosis, depth of dissection beyond subcutaneous tissue, size of excision, amount of undermining required, and layered closure technique. Photos and measurements in centimeters strengthen documentation.

Can I bill skin grafts or complex closure with CPT 11451?

Yes, complex closures (13100-13102) and skin grafts (15100-15101) are separately reportable with CPT 11451 when performed and documented. These are not included in the excision code and should be billed separately with appropriate documentation of size and technique.

What ICD-10 code should be used with CPT 11451?

The primary diagnosis code is L73.2 (Hidradenitis suppurativa). Ensure documentation specifies axillary location and chronic nature. Secondary codes may include L02.415/L02.416 for axillary abscess if acute infection is present, or codes documenting complications like scarring or functional impairment.