CPT 17266Surgery

Dstrj mal les t/a/l >4.0 cm

CPT code 17266 is used when a physician destroys a malignant (cancerous) skin lesion on the trunk, arms, or legs that is larger than 4.0 centimeters using methods like freezing, laser, or chemical destruction.

Showing rates for

National Average

Base Medicare rate

$229.01

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

2.39

PE RVU (NF)

4.44

MP RVU

0.25

Total RVU

7.08

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

NCCI bundling edits

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Billing tips

Document exact lesion size in centimeters (not just '>4 cm') with measurement method (ruler, calipers, photographic documentation) before destruction to prevent downcoding
Impact: Prevents downcoding to 17264 (3.1-4.0 cm at $184.13), protecting $44.88 per lesion in reimbursement
Always confirm pathology report confirms malignancy before billing 17266; destruction of premalignant lesions requires different codes (17000-17004)
Impact: Prevents denials and potential fraud allegations; malignant vs premalignant coding difference is approximately $200+ per lesion
Bill facility code (17266 with POS 22 or 24) at $149.76 when performed in ASC or hospital versus non-facility rate of $229.01 in office to ensure correct reimbursement
Impact: Using wrong place of service can trigger $79.25 overpayment recoupment or audit flags
For multiple lesions destroyed in same session, bill 17266 for the largest lesion and use appropriate add-on codes or repeat 17266 with modifier 59 for additional qualifying lesions
Impact: Proper sequencing and modifier use prevents bundling and maximizes reimbursement at $229.01 per distinct lesion
Submit clean claims with ICD-10 codes specifying malignancy type (C44.x codes for skin malignancy) and anatomical site matching the trunk/arm/leg descriptor
Impact: Reduces denial rate by 30-40% and prevents medical necessity denials that delay payment 45-60 days
When destruction requires multiple treatment sessions, document each as separate encounters with updated measurements and clinical necessity for staged approach
Justifies billing for each session versus being bundled into single payment; can result in 2-3x reimbursement for complex cases

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Frequently asked questions

What is the CPT code 17266 used for?

CPT 17266 is used for the destruction of a malignant skin lesion on the trunk, arms, or legs that measures greater than 4.0 centimeters in diameter. The destruction can be performed using cryotherapy, electrosurgery, laser, or chemical methods, and is specifically for non-excisional treatment of cancerous lesions.

How much does Medicare pay for CPT code 17266 in 2025?

In 2025, Medicare pays $229.01 for CPT 17266 when performed in a non-facility setting (physician office) and $149.76 when performed in a facility setting (hospital outpatient department or ambulatory surgery center). These are national average rates and may vary by geographic locality.

What is the difference between CPT 17266 and 17264?

The difference is lesion size: CPT 17264 is for malignant lesions measuring 3.1 to 4.0 cm, while CPT 17266 is for lesions greater than 4.0 cm. Both codes are for destruction of malignant lesions on trunk, arms, or legs, but 17266 reimburses at a higher rate ($229.01 vs $184.13) due to the larger lesion size requiring more physician work.

Can CPT 17266 be billed multiple times on the same day?

Yes, CPT 17266 can be billed multiple times on the same day if multiple distinct malignant lesions each exceeding 4.0 cm are destroyed in separate anatomical locations. Use modifier 59 or XS to indicate each lesion is a separate, identifiable procedure, and document each lesion's size and specific location clearly.

What RVU value does CPT 17266 have?

CPT 17266 has a total RVU of 7.08 in 2025, consisting of 2.39 work RVUs, 4.44 non-facility practice expense RVUs (1.99 facility PE RVUs), and 0.25 malpractice RVUs. These relative value units reflect the resources required to perform the procedure.

What diagnosis codes can be used with CPT 17266?

CPT 17266 requires ICD-10 diagnosis codes indicating malignant skin neoplasms on appropriate anatomical sites, primarily C44.x codes such as C44.501-C44.599 (trunk), C44.601-C44.629 (upper limb/shoulder), and C44.701-C44.729 (lower limb/hip). The specific code must match the anatomical location of the destroyed lesion and indicate confirmed malignancy.

Is a biopsy required before billing CPT 17266?

While not explicitly required by the CPT code itself, medical necessity and standard of care typically require pathological confirmation of malignancy before destruction of a lesion. Most payers require documentation of a previous biopsy confirming malignancy or simultaneous biopsy results to support billing 17266 rather than codes for premalignant or benign lesion destruction.