CPT 17004Surgery

Destroy premal lesions 15/>

CPT 17004 is an add-on code used when a doctor destroys 15 or more premalignant skin lesions (abnormal growths that could become cancerous) during a single visit. This code is always billed alongside base codes for destroying the first lesions.

Showing rates for

National Average

Base Medicare rate

$161.73

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

1.37

PE RVU (NF)

3.47

MP RVU

0.16

Total RVU

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

NCCI bundling edits

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Billing tips

Always verify total lesion count reaches exactly 15 or more before billing 17004. Bill 17003 for 2-14 lesions to avoid downcoding.
Impact: Incorrect count selection causes automatic denial or downcoding from $161.73 to lower tier; can result in $50-80 revenue loss per claim
CPT 17004 can only be billed once per session regardless of total lesion count (whether 15, 25, or 50+ lesions treated). Do not bill multiple units.
Impact: Billing multiple units triggers automatic denial of secondary units; prevents $161.73 overpayment recovery and potential audit flags
Document exact lesion count in operative note with specific anatomical locations (e.g., '8 lesions on scalp, 7 on right forearm, 4 on left forearm = 19 total').
Impact: Vague documentation like 'multiple lesions' increases audit risk by 65% and denial rate; specific counts support $161.73 payment
Bill 17004 with either 17000 (first lesion) or 17003 (2-14 lesions), never both. Most commonly paired with 17003 when total count is 15+.
Impact: Incorrect pairing with both base codes triggers NCCI edit denial; proper pairing with 17003 alone yields combined payment of approximately $200+
Facility vs. non-facility setting choice impacts reimbursement by $65.34. Verify place of service code matches actual treatment location.
Impact: Incorrect POS code (office vs. hospital outpatient) causes $65.34 payment differential and potential overpayment recovery audits
For field treatment modalities (photodynamic therapy, topical chemotherapy), use appropriate codes (96567, 96573) instead of 17004 for better reimbursement alignment.

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Frequently asked questions

What is the Medicare reimbursement for CPT code 17004 in 2025?

Medicare pays $161.73 for CPT 17004 in non-facility settings and $96.39 in facility settings under the 2025 Medicare Physician Fee Schedule. The total RVU is 5.0 (1.37 work RVU, 3.47 non-facility PE RVU, 0.16 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

Can CPT 17004 be billed alone or does it require another code?

CPT 17004 cannot be billed alone - it is an add-on code that must be reported with either CPT 17000 (destruction of first premalignant lesion) or CPT 17003 (destruction of 2-14 lesions). Most commonly, 17004 is billed with 17003 when the total lesion count is 15 or more.

How many lesions must be destroyed to bill CPT 17004?

Exactly 15 or more premalignant lesions must be destroyed to bill CPT 17004. If fewer than 15 lesions are treated, use CPT 17000 (for 1 lesion) or 17003 (for 2-14 lesions) instead. Code 17004 is billed only once per session regardless of whether 15, 25, or more lesions are destroyed.

Can I bill multiple units of CPT 17004 if I destroy 30 or more lesions?

No, CPT 17004 should only be billed once per session regardless of the total number of lesions destroyed beyond 15. Whether you treat 15, 30, or 50+ lesions, you bill 17004 once along with the appropriate base code (17000 or 17003). Multiple units will be denied as incorrect coding.

What documentation is required to support billing CPT 17004?

Documentation must include the exact count of lesions destroyed (minimum 15), specific anatomical locations, method of destruction (cryotherapy, chemical, etc.), clinical diagnosis (typically actinic keratosis), and medical necessity for treating multiple lesions in one session. Vague terms like 'multiple lesions' increase denial risk significantly.

What is the difference between CPT 17003 and 17004?

CPT 17003 covers destruction of 2-14 premalignant lesions, while CPT 17004 covers destruction of 15 or more lesions. Both are add-on codes but 17003 pairs with 17000 (first lesion) while 17004 can pair with either 17000 or 17003. The lesion count threshold determines which code to use, with 17004 providing higher reimbursement for extensive disease.

Does CPT 17004 apply to facility or non-facility settings?

CPT 17004 applies to both settings but with different reimbursement rates. Non-facility (office) settings receive $161.73 while facility settings (hospital outpatient departments, ASCs) receive $96.39 from Medicare in 2025. The place of service code on your claim must accurately reflect where the procedure was performed to ensure correct payment.