CPT 15786Surgery

Abrasion lesion single

CPT code 15786 covers the surgical removal of a single skin lesion using abrasion techniques like dermabrasion or chemical peeling to smooth or remove abnormal skin growth.

Showing rates for

National Average

Base Medicare rate

$220.93

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

2.08

PE RVU (NF)

4.54

MP RVU

0.21

Total RVU

6.83

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

NCCI bundling edits

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Billing tips

Verify single versus multiple lesion coding before claim submission - 15787 covers 2-4 lesions and may be more appropriate if multiple lesions treated
Impact: Using 15787 instead of multiple units of 15786 can increase reimbursement by $150-300 and reduce audit risk for unbundling
Document the specific abrasion method used (mechanical dermabrasion, chemical peel agent, or laser type) and medical necessity for lesion removal
Impact: Prevents denials for cosmetic exclusions; Medicare and commercial payers deny approximately 30% of claims lacking clear medical necessity documentation
Bill in non-facility setting when performed in office to capture the $88.96 differential between non-facility ($220.93) and facility ($131.97) rates
Impact: Direct revenue impact of $88.96 per procedure; over 100 procedures annually equals $8,896 additional practice revenue
Append modifier 25 to same-day E/M only when documentation clearly shows separate medical decision-making beyond the decision to perform the procedure
Impact: Proper modifier 25 use can add $75-200 per encounter but improper use triggers high audit risk with potential recoupment
Photograph lesions before and after treatment when billing for premalignant or suspicious lesions to support medical necessity
Impact: Reduces denial rate by approximately 40% for medical necessity challenges and strengthens appeal success rate to 85%+
Query pathology results if biopsy performed and link diagnosis codes to pathology findings rather than presumptive clinical diagnoses
Accurate diagnosis coding based on pathology reduces claim rejections by 25% and supports appropriate coverage determination

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 15786 in 2025?

The 2025 Medicare national average reimbursement for CPT 15786 is $220.93 in the non-facility setting and $131.97 in the facility setting. These rates are based on the total RVU of 6.83 and the 2025 conversion factor of 32.3465. Actual reimbursement may vary based on geographic locality adjustments.

How many RVUs is CPT code 15786 worth?

CPT 15786 has a total RVU value of 6.83, consisting of 2.08 work RVUs, 4.54 practice expense RVUs (non-facility), 1.79 practice expense RVUs (facility), and 0.21 malpractice RVUs. This reflects moderate procedural complexity and resource utilization.

Can I bill CPT 15786 for multiple lesions on the same patient?

No, CPT 15786 specifically covers abrasion of a single lesion only. For 2-4 lesions, use CPT 15787 instead. For 5 or more lesions, use the appropriate add-on codes. Billing multiple units of 15786 for multiple lesions is considered incorrect coding and may trigger audits for unbundling.

What is the difference between CPT 15786 and destruction codes like 17000?

CPT 15786 covers surgical abrasion techniques (dermabrasion, chemical peeling, laser resurfacing) that mechanically or chemically remove tissue layers, while 17000 series codes cover destruction methods (cryotherapy, electrosurgery, curettage). The technique used and documentation should clearly support the appropriate code selection.

Does Medicare cover CPT 15786 for cosmetic dermabrasion?

No, Medicare and most commercial payers do not cover CPT 15786 when performed solely for cosmetic purposes such as wrinkle reduction or scar revision. Coverage requires documented medical necessity such as premalignant lesion removal, symptomatic lesion treatment, or functional impairment.

Can I bill an E/M visit with CPT 15786 on the same day?

Yes, you can bill an E/M service with CPT 15786 on the same day if the E/M represents a separately identifiable service beyond the decision to perform the procedure. Append modifier 25 to the E/M code and ensure documentation clearly shows distinct evaluation and management work.

What diagnosis codes support medical necessity for CPT 15786?

Diagnosis codes that typically support medical necessity for CPT 15786 include actinic keratosis (L57.0), seborrheic keratosis (L82.x series), verruca (B07.x series), and other benign or premalignant lesions. Cosmetic diagnoses or purely aesthetic concerns will likely result in denial. Always link the most specific diagnosis based on clinical findings or pathology results.