CPT 11462Surgery

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CPT code 11462 covers the surgical removal of hidradenitis suppurativa lesions (painful, inflamed sweat gland nodules) when the excision is simple or intermediate complexity. This involves cutting out infected tissue from areas like the armpits or groin.

Showing rates for

National Average

Base Medicare rate

$408.54

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

PE RVU (NF)

8.97

MP RVU

0.66

Total RVU

12.63

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

NCCI bundling edits

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Billing tips

Bill in non-facility setting when clinically appropriate to maximize reimbursement
Impact: $159.80 additional revenue per procedure (39% increase over facility rate)
Document total excised area dimensions and depth to support intermediate vs simple classification and defend against downcoding to 11450-11451
Impact: Prevents potential $100-200 downcoding loss per claim
When performing bilateral procedures, use modifier 50 rather than billing two separate line items to ensure proper 150% reimbursement
Impact: Ensures correct $612.81 payment vs potential underpayment or denial
Separately bill for pathology services (88305) as these are not included in the surgical global package
Impact: Additional $80-120 in ancillary revenue per specimen
Link appropriate ICD-10 codes (L73.2 for hidradenitis suppurativa) and document failed conservative treatment to establish medical necessity
Impact: Reduces denial rate by 15-25% based on clear medical necessity documentation
For extensive cases requiring layered closure or undermining beyond intermediate level, consider coding 11463 instead for complex repair
Impact: Potential additional $100-150 reimbursement for appropriately complex cases

Common denials

Lack of medical necessity documentation - insufficient evidence of failed conservative treatment

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Frequently asked questions

What is the Medicare reimbursement for CPT code 11462 in 2025?

Medicare pays $408.54 for CPT 11462 in non-facility settings and $248.74 in facility settings based on the 2025 national average rates. The total RVU is 12.63 with a conversion factor of 32.3465.

What is the difference between CPT 11462 and 11450?

CPT 11450 covers simple hidradenitis excision with simple repair, while 11462 involves simple or intermediate complexity. Code 11462 typically involves larger excisions, layered closures, or cases with moderate scarring/sinus tracts, justifying higher reimbursement at $408.54 vs approximately $250 for 11450.

Can you bill CPT 11462 bilaterally with modifier 50?

Yes, modifier 50 is appropriate when performing bilateral hidradenitis excisions during the same operative session (e.g., both axillae). This increases reimbursement to 150% of the base rate, resulting in $612.81 payment in non-facility settings.

What diagnosis codes support medical necessity for CPT 11462?

The primary diagnosis code is L73.2 (hidradenitis suppurativa). Documentation should include evidence of chronic, recurrent disease and failed conservative management with antibiotics, anti-inflammatories, and lifestyle modifications over an appropriate trial period.

How many RVUs is CPT code 11462 worth?

CPT 11462 has a total of 12.63 RVUs, consisting of 3.0 work RVUs, 8.97 practice expense RVUs (non-facility), 4.03 PE RVUs (facility), and 0.66 malpractice RVUs based on 2025 Medicare rates.

What is included in the global period for CPT 11462?

CPT 11462 has a 90-day global period, meaning routine pre-operative and post-operative care is bundled into the reimbursement. This includes the initial consultation, the procedure itself, and typical follow-up visits within 90 days. Complications requiring return to OR may be separately billable with appropriate modifiers.

Can you bill an E/M visit on the same day as CPT 11462?

Yes, but only with modifier 25 appended to the E/M code if a separately identifiable evaluation and management service was performed beyond the routine pre-operative assessment. Documentation must clearly show the distinct nature of the E/M service, such as evaluation of unrelated conditions or extensive history/decision-making beyond surgical planning.