CPT 17263Surgery

Dstrj mal les t/a/l 2.1-3.0

CPT 17263 covers the destruction of a malignant (cancerous) skin lesion on the trunk, arms, or legs that measures between 2.1 and 3.0 centimeters in diameter. This typically involves removing the cancerous tissue using techniques like freezing, burning, or laser treatment.

Showing rates for

National Average

Base Medicare rate

$187.61

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

1.84

PE RVU (NF)

3.78

MP RVU

0.18

Total RVU

5.8

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

NCCI bundling edits

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Billing tips

Measure and document lesion size in centimeters before treatment begins, not after destruction—use the greatest clinical diameter
Impact: Prevents downcoding from 17263 ($187.61) to 17262 ($145.23), protecting $42.38 per lesion
Verify pathology report confirms malignancy before submitting claim; include diagnosis codes matching pathology findings (C44.x series)
Impact: Prevents 100% denials for lack of medical necessity—malignancy must be documented, not suspected
Bill only one destruction code per lesion regardless of technique used; do not separately bill for anesthesia or lesion prep
Impact: Avoids unbundling denials and recoupment of $50-150 in incorrectly billed ancillary services
For lesions at size boundaries (exactly 2.0 or 3.0 cm), round to nearest tenth and document clearly; 3.0 cm qualifies for 17263
Impact: Ensures correct code selection at critical thresholds where payment differs by $30-50
When treating multiple lesions, list 17263 on separate line items with modifier 59 or appropriate NCCI modifier, not as units
Impact: Maximizes reimbursement—each lesion paid separately versus bundled denial of secondary lesions
For facility billing, recognize $68.25 payment differential between facility ($119.36) and non-facility ($187.61) settings
Impact: Place of service code accuracy (11 vs 22) directly affects payment by 36% or $68.25 per procedure

Applicable modifiers

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Frequently asked questions

What is the Medicare reimbursement for CPT code 17263 in 2025?

The 2025 Medicare national average reimbursement for CPT 17263 is $187.61 in non-facility settings (office) and $119.36 in facility settings (hospital outpatient or ASC). Actual payment may vary based on geographic locality adjustments.

What size lesion qualifies for CPT 17263?

CPT 17263 is used for malignant lesions measuring 2.1 to 3.0 centimeters in greatest clinical diameter. The measurement must be taken before treatment begins and documented in the medical record. Lesions smaller than 2.1 cm use code 17262, while those larger than 3.0 cm use 17264.

Can I bill CPT 17263 for multiple lesions on the same patient?

Yes, you can bill 17263 for each separate malignant lesion measuring 2.1-3.0 cm that is destroyed. List each lesion on a separate line item with modifier 59 or XS to indicate distinct lesions. Do not use units; bill each lesion separately with appropriate documentation of location and size.

What body areas are covered by CPT 17263?

CPT 17263 covers destruction of malignant lesions on the trunk (chest, back, abdomen), arms (shoulder to hand), and legs (hip to foot). It does NOT include lesions on the face, ears, eyelids, nose, lips, or mucous membranes, which have separate code series.

Do I need a biopsy before billing CPT 17263?

Yes, pathology confirmation of malignancy is required before performing and billing destruction procedures coded with 17263. The pathology report must show a malignant diagnosis such as basal cell carcinoma, squamous cell carcinoma, or melanoma in situ. Clinical suspicion alone is not sufficient for reimbursement.

What is the difference between CPT 17263 and 17262?

The only difference is lesion size: 17262 covers lesions 1.1-2.0 cm (pays $145.23 non-facility) while 17263 covers lesions 2.1-3.0 cm (pays $187.61 non-facility). Both apply to malignant lesions on trunk, arms, or legs. Accurate measurement documentation is critical to support the appropriate code.

Can I bill an E/M visit with CPT 17263 on the same day?

Yes, if a significant, separately identifiable evaluation and management service is performed, you can bill both services using modifier 25 on the E/M code. The E/M must be beyond the usual pre-procedure evaluation and documented separately. Common scenarios include new lesion evaluation, assessment of other conditions, or complex decision-making beyond the destruction procedure itself.