CPT 17261Surgery

Dstrj mal les t/a/l .6-1.0cm

CPT code 17261 covers the destruction of a malignant skin lesion (such as skin cancer) located on the trunk, arms, or legs, measuring between 0.6 and 1.0 centimeters in diameter. This typically involves methods like cryotherapy, electrosurgery, or laser to remove cancerous tissue.

Showing rates for

National Average

Base Medicare rate

$144.27

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

1.22

PE RVU (NF)

3.11

MP RVU

0.13

Total RVU

4.46

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

NCCI bundling edits

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Billing tips

Verify and document lesion size at greatest diameter before destruction, as measurements determine code selection between 17260 (≤0.5cm), 17261 (0.6-1.0cm), 17262 (1.1-2.0cm), etc.
Impact: Incorrect size documentation can result in $30-80 payment variance; undersizing costs revenue while oversizing risks audit recoupment
Bill 17261 only once per lesion regardless of number of treatment sessions; subsequent treatments of the same lesion use modifier 76 or 58 depending on timing and planning
Impact: Duplicate billing without modifiers results in 100% denial; proper modifier use maintains payment eligibility
Confirm anatomic site eligibility (trunk, arms, legs) as face, ears, eyelids, nose, lips, mucous membranes use different code sets (17260-17286 vs 17311-17315)
Impact: Wrong anatomic code family results in automatic denial; site-specific codes may reimburse $50-200 differently
Obtain and reference pathology report confirming malignancy in documentation; premalignant lesions (actinic keratosis) use 17000-17004 series instead
Impact: Lack of malignancy confirmation triggers medical necessity denial; 17000 series pays $68-120 less than malignant lesion codes
Bill in facility setting (ASC, HOPD) when appropriate to reduce overhead while accepting lower facility rate of $86.04 vs $144.27 non-facility
Impact: Strategic setting selection optimizes practice economics; facility technical fee separate from professional component
Document destruction method, pre-procedure site marking, lesion diameter measurement tool used, and complete destruction of margins

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 17261 in 2025?

The 2025 Medicare national average payment for CPT 17261 is $144.27 in non-facility settings and $86.04 in facility settings. Actual reimbursement varies by geographic locality based on the GPCI adjustment factors applied to your area.

How many RVUs is CPT code 17261 worth?

CPT 17261 has a total RVU value of 4.46, consisting of 1.22 work RVUs, 3.11 non-facility practice expense RVUs (1.31 facility PE RVUs), and 0.13 malpractice RVUs for 2025.

Can I bill CPT 17261 for multiple lesions on the same day?

Yes, you can bill 17261 for each separate lesion treated within the 0.6-1.0cm size range. Append modifier 59 to subsequent lesions to indicate distinct procedural services, and document each lesion's size and specific anatomic location separately.

What is the difference between CPT 17261 and 17260?

CPT 17260 is for malignant lesion destruction up to 0.5cm diameter, while 17261 covers lesions 0.6-1.0cm. The size difference results in different reimbursement rates, with 17261 paying approximately $30-40 more due to increased complexity and time required.

Do I need a biopsy before billing CPT 17261?

Yes, you must have histologic confirmation of malignancy either from a prior biopsy or from pathology examination of the destroyed tissue. Documentation must include the pathology report confirming the malignant diagnosis to support medical necessity.

Can CPT 17261 be billed with an E/M service on the same day?

Yes, but only when the E/M service is separately identifiable and goes beyond the decision for the destruction procedure. Append modifier 25 to the E/M code and ensure documentation clearly supports a distinct evaluation beyond the minor pre-procedure assessment.

What anatomic sites are covered under CPT 17261?

CPT 17261 covers malignant lesion destruction on the trunk, arms, and legs only. It excludes face, ears, eyelids, nose, lips, mucous membranes, hands, feet, and genitalia, which have separate CPT codes with different reimbursement rates.