CPT 17264Surgery

Dstrj mal les t/a/l 3.1-4.0

CPT code 17264 is used when a physician destroys a cancerous skin lesion on the trunk, arms, or legs that measures between 3.1 and 4.0 centimeters (about 1.2-1.6 inches) using methods like electrosurgery, cryotherapy, laser, or chemical treatment.

Showing rates for

National Average

Base Medicare rate

$201.52

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

1.99

PE RVU (NF)

4.03

MP RVU

0.21

Total RVU

6.23

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 in two dimensions before destruction; 17264 requires 3.1-4.0 cm measurement
Impact: Incorrect size documentation can result in downcoding to 17263 ($166.84) or upcoding denials to 17266 ($271.50), representing potential $35-70 payment variance
Bill only once per lesion regardless of number of treatment sessions; subsequent treatments of same lesion are included
Impact: Prevents denials for duplicate billing; attempted multiple billings typically result in 100% claim denial and potential audit flags
Verify anatomic location is trunk, arms, or legs; face/scalp/neck lesions require different code series (17260-17263)
Impact: Wrong anatomic location codes result in claim denials and rebilling delays averaging 30-45 days for payment correction
Document destruction method (cryosurgery, electrosurgery, laser, chemical) and confirm lesion malignancy with prior biopsy results
Impact: Missing pathology confirmation results in denial to non-malignant code series (17110-17111) reducing payment to $86.52, a loss of $115.00
Bill in non-facility setting when performed in office to capture full $201.52 rate versus $128.09 facility rate
Impact: Strategic setting optimization increases revenue by $73.43 per procedure (36% higher reimbursement) when overhead costs support office-based delivery
Use modifier 25 with supporting E/M documentation when same-day visit involves separate medical decision-making beyond procedure
Impact: Properly documented modifier 25 can add $70-180 for level 3-4 E/M services; improper use triggers bundling edits resulting in $0 for E/M component

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 17264 in 2025?

The 2025 Medicare national average reimbursement for CPT 17264 is $201.52 in non-facility settings and $128.09 in facility settings. These rates are based on 6.23 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on GPCI adjustments.

Can CPT 17264 be billed multiple times on the same day?

Yes, CPT 17264 can be billed for each separate lesion destroyed on the same day, provided each lesion meets the size criteria (3.1-4.0 cm) and is in a distinct anatomic location. Use modifier 59 on subsequent lesions to indicate separate procedures. However, you cannot bill multiple times for treating the same lesion across multiple sessions.

What is the difference between CPT 17264 and 17263?

CPT 17264 is for malignant lesion destruction sized 3.1-4.0 cm, while 17263 covers 2.1-3.0 cm lesions. Both are for trunk, arms, or legs locations. The size difference results in different reimbursement: 17264 pays $201.52 versus $166.84 for 17263 in non-facility settings, a $34.68 difference.

Do I need a biopsy before billing CPT 17264?

Yes, you must have pathology confirmation of malignancy before billing CPT 17264. The biopsy can be from a previous date of service, but documentation must link the destroyed lesion to the biopsy-confirmed malignant diagnosis. Without pathology confirmation, the appropriate codes would be from the benign lesion series (17110-17111).

Can CPT 17264 be billed with an E/M code on the same day?

Yes, but only when the E/M service represents a separately identifiable service beyond the decision to perform the destruction. Use modifier 25 on the E/M code and document the separate medical decision-making. The E/M should address issues beyond the procedure itself, such as evaluation of other conditions or initial diagnostic workup.

What destruction methods are included in CPT 17264?

CPT 17264 includes destruction by any method: electrosurgery (electrodesiccation, electrofulguration), cryosurgery (liquid nitrogen), laser ablation (CO2, erbium), or chemical destruction (trichloroacetic acid). The code does not specify method, so physician choice is based on clinical appropriateness. The method used should be documented in the operative note.

How do facility and non-facility rates differ for CPT 17264?

Non-facility (office) settings receive $201.52 because the practice absorbs all equipment, supplies, and overhead costs. Facility settings (hospital outpatient, ASC) receive $128.09 because the facility bills separately for resources. The $73.43 difference (36% reduction) reflects the practice expense component that shifts to the facility when performed in that setting.