CPT 17260Surgery

Dstrj mal les t/a/l 0.5 cm/<

CPT code 17260 covers the destruction of a small malignant (cancerous) skin lesion on the trunk, arms, or legs that measures 0.5 centimeters or smaller. This is typically done using methods like freezing, burning, or laser treatment to remove skin cancer without surgery.

Showing rates for

National Average

Base Medicare rate

$97.04

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

0.96

PE RVU (NF)

1.94

MP RVU

0.1

Total RVU

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

NCCI bundling edits

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Billing tips

Bill 17260 for the first lesion only; use add-on code 17261 for each additional lesion destroyed during same session
Impact: Improper sequencing results in undercoding; 17261 pays approximately $35-45 per additional lesion, potentially losing hundreds in revenue for multiple lesions
Document exact lesion size with measurement tool (not visual estimation) before destruction, as diameter determines code selection between 17260-17264
Impact: Upcoding to 17261-17264 without documentation risks $50-300 overpayment per lesion and potential fraud investigation; precise measurement ensures compliant billing
Verify malignancy with pathology report or biopsy confirmation before billing 17260; premalignant lesions require different code series (17000-17004)
Impact: Coding premalignant lesions as malignant results in overpayment of approximately $50-70 per lesion and constitutes upcoding; use 17000 for actinic keratosis
Bill non-facility rate ($97.04) when performed in office setting; facility rate ($69.22) applies only to hospital outpatient departments
Impact: Ensures correct payment differential of $27.82 per procedure; incorrect place of service coding results in automatic rate adjustment and potential audit
Append modifier 25 to E/M code when performing same-day evaluation and destruction, with documentation supporting separately identifiable service
Impact: Without modifier 25, E/M service is bundled into procedure, losing $100-250 in legitimate reimbursement; modifier requires clear documentation of distinct evaluation
Do not bill 17260 with excision codes (11600-11646) for same lesion; destruction and excision are mutually exclusive treatment methods

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 17260 in 2025?

Medicare pays $97.04 for CPT 17260 in non-facility settings (physician offices) and $69.22 in facility settings (hospital outpatient departments) based on the 2025 national average rates. Actual reimbursement varies by geographic locality using the GPCI adjustment factor.

Can I bill CPT 17260 for multiple lesions on the same day?

No, CPT 17260 is reported only once per session for the first malignant lesion destroyed. For each additional lesion treated during the same session, report add-on code 17261. Never report 17260 more than once per date of service regardless of the number of lesions treated.

What is the difference between CPT 17260 and 17000?

CPT 17260 is for destruction of malignant lesions (confirmed cancer) on trunk/arms/legs, while 17000 is for premalignant lesions like actinic keratosis. The distinction requires pathology confirmation or clinical diagnosis documentation. 17260 reimburses significantly higher at $97.04 versus approximately $40-50 for 17000.

How many RVUs is CPT code 17260 worth?

CPT 17260 has a total RVU value of 3.00, consisting of 0.96 work RVUs, 1.94 non-facility practice expense RVUs (1.08 facility PE RVUs), and 0.10 malpractice RVUs. These values are from the CMS 2025 Medicare Physician Fee Schedule.

Can I bill an E/M visit with CPT 17260 on the same day?

Yes, you can bill an E/M service with 17260 on the same day if the evaluation is separately identifiable and documented beyond the decision to perform the procedure. Append modifier 25 to the E/M code and ensure documentation clearly supports a distinct evaluation with separate history, exam, or medical decision-making.

What documentation is required to bill CPT 17260?

Required documentation includes specific anatomic location, measured lesion diameter (must be ≤0.5 cm), malignancy confirmation via pathology or clinical diagnosis, destruction method used, and number of lesions treated. Missing lesion size measurement is the most common documentation deficiency leading to denials.

Does CPT 17260 include follow-up visits?

Yes, CPT 17260 includes a 10-day global period, meaning routine post-procedure follow-up visits within 10 days are bundled into the procedure payment and cannot be billed separately. Complications or unrelated services during this period may be billable with appropriate modifiers (24 for unrelated E/M, 78 for related procedure).