CPT 11470Surgery

Exc skn h/p/p/u smpl/ntrm

CPT code 11470 covers the surgical removal of diseased sweat glands and infected tissue in the armpit area, typically for hidradenitis suppurativa (chronic painful lumps and abscesses). This is a simple or intermediate complexity excision in the axilla.

Showing rates for

National Average

Base Medicare rate

$440.56

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

3.74

PE RVU (NF)

9.11

MP RVU

0.77

Total RVU

13.62

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

NCCI bundling edits

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Billing tips

Document wound closure complexity explicitly (simple vs intermediate) to justify 11470 over simple excision codes
Impact: Prevents downcoding to 11400-series codes which reimburse $150-200 less; intermediate closure requires layered closure documentation
Report facility vs non-facility setting correctly based on actual site of service
Impact: $157.20 difference between settings; ASC and hospital outpatient are facility settings; office with full surgical suite may qualify as non-facility
For bilateral procedures, use modifier 50 on single line rather than billing LT and RT separately
Impact: Ensures proper 150% payment ($660.84) rather than risk of second side denial or incorrect 100% + 50% calculation
Bundle simple I&D performed at same session into 11470; only report separately if performed at different site/session
Impact: Prevents unbundling denials; I&D codes 10060-10061 are included in excision work; saves $50-100 in denials/appeals
Link to specific ICD-10 codes for hidradenitis (L73.2) or hyperhidrosis (L75.0) rather than generic abscess codes
Impact: Reduces medical necessity denials by 30-40%; generic codes like L02.415 may trigger prior authorization or denial
For extensive/complex hidradenitis requiring flap/graft closure, code 11471 instead of 11470 with modifier 22
Impact: 11471 reimburses at higher rate with proper documentation; modifier 22 appeals have 60-70% denial rate while correct initial coding avoids appeals

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 11470 in 2025?

Medicare pays $440.56 for CPT 11470 in non-facility settings and $283.36 in facility settings (ASC, hospital outpatient) based on the 2025 Physician Fee Schedule. The difference reflects overhead costs covered by facility fees in hospital/ASC settings.

What is the difference between CPT 11470 and 11471?

CPT 11470 is for simple or intermediate complexity axillary hidradenitis excision with direct or layered closure, while 11471 is for complex excision requiring flap or graft closure. Code selection depends on wound closure complexity, not excision size alone. Document closure technique clearly to support code choice.

Can CPT 11470 be billed bilaterally?

Yes, CPT 11470 can be billed bilaterally when both axillae are treated in the same operative session using modifier 50 for 150% reimbursement, or with modifiers LT/RT on separate line items per payer policy. Always verify individual payer requirements for bilateral modifier formatting.

How many RVUs is CPT code 11470 worth?

CPT 11470 has 13.62 total RVUs: 3.74 work RVUs, 9.11 non-facility practice expense RVUs (4.25 facility), and 0.77 malpractice RVUs. This moderate RVU value reflects the surgical skill and practice expense for axillary tissue excision with intermediate closure.

What diagnosis codes support medical necessity for CPT 11470?

Primary diagnosis codes include L73.2 (hidradenitis suppurativa), L75.0 (bromhidrosis/apocrine miliaria), R61 (hyperhidrosis), and L02.415 (axillary abscess). Hidradenitis suppurativa (L73.2) provides strongest support; hyperhidrosis may require prior authorization and documentation of conservative treatment failure.

Is CPT 11470 subject to the global surgical package?

Yes, CPT 11470 has a 90-day global period. All related postoperative care including wound checks, suture removal, and routine follow-up within 90 days is included in the reimbursement. Unrelated E/M services require modifier 24; complications requiring return to OR use modifier 78.

Can I bill an E/M code with CPT 11470 on the same day?

Yes, but only with modifier 25 if a separately identifiable, significant E/M service is documented beyond the usual preoperative assessment. The E/M must address different problems or extend substantially beyond surgical decision-making. Most same-day visits are bundled unless clearly distinct and documented.