CPT 17274Surgery

Dstr mal les s/n/h/f/g 3.1-4

CPT code 17274 covers the destruction (removal by burning, freezing, or laser) of a cancerous skin lesion measuring 3.1 to 4.0 centimeters on the scalp, neck, hands, feet, or genitals. These are areas where skin cancer treatment requires extra care due to complex anatomy.

Showing rates for

National Average

Base Medicare rate

$238.39

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

2.64

PE RVU (NF)

4.45

MP RVU

0.28

Total RVU

7.37

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

NCCI bundling edits

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Billing tips

Verify site of service before scheduling: non-facility setting pays $238.39 vs $164 in facility, a $74.39 difference per procedure
Impact: $74.39 per case revenue difference; on 100 annual cases this represents $7,439 in practice revenue variation
Document precise lesion diameter in two dimensions and photograph with ruler before destruction to support size-based coding; 17274 is for 3.1-4.0 cm only
Impact: Prevents downcoding from 17274 ($238.39) to 17273 ($191.68) - a $46.71 loss per incorrect measurement
Confirm anatomic location is scalp, neck, hands, feet, or genitalia; lesions on trunk/arms/legs use different code series (17260-17266) with lower reimbursement
Impact: Using wrong anatomic series can result in $50-$100 payment difference; trunk lesions reimburse approximately 30% less than hands/feet/genitalia codes
Bill each lesion separately when treating multiple malignant lesions; use appropriate size code for each and apply modifier 59 to subsequent lesions
Impact: Additional lesions typically pay at 50% of primary procedure rate; second 17274 would add approximately $119 with modifier
Ensure pathology report confirming malignancy is in chart before billing; payers may deny without prior biopsy documentation
Impact: Prevents 100% denial and appeal costs; initial denials require 30-60 days appeal timeline and administrative burden averaging $25-$40 per appeal
For lesions at borderline measurements (exactly 3.0 or 4.0 cm), document margin requirements and measure at widest diameter; round up per CPT guidelines
Proper measurement interpretation can justify 17274 vs 17273 coding, worth $46.71 difference in Medicare reimbursement

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Frequently asked questions

What is the CPT code 17274 used for?

CPT 17274 is used for the destruction of a malignant skin lesion measuring 3.1 to 4.0 centimeters located on the scalp, neck, hands, feet, or genitalia. Destruction methods include electrosurgery, cryosurgery, laser, or chemical treatment. A prior biopsy confirming malignancy is required before this code can be billed.

How much does Medicare pay for CPT code 17274 in 2025?

Medicare pays $238.39 for CPT 17274 in non-facility settings (physician office) and $164.00 in facility settings (hospital outpatient department or ambulatory surgery center) based on the 2025 national average rates. Actual payment may vary by geographic location based on locality adjustments.

What is the difference between CPT 17273 and 17274?

The difference is lesion size: CPT 17273 covers malignant lesions 2.1 to 3.0 cm, while 17274 covers lesions 3.1 to 4.0 cm. Both require the same anatomic locations (scalp, neck, hands, feet, genitalia). The size difference results in different reimbursement, with 17274 paying approximately $46.71 more than 17273 under Medicare.

Can I bill CPT 17274 for multiple lesions on the same day?

Yes, you can bill 17274 for each separate malignant lesion treated, as long as each lesion meets the size criteria (3.1-4.0 cm) and is in a qualifying location. Append modifier 59 or XS to the second and subsequent lesions to indicate they are distinct procedures. Each lesion requires separate documentation and measurement.

What documentation is needed to support billing CPT 17274?

Required documentation includes: pathology report confirming malignancy, precise lesion measurements in centimeters (before destruction), specific anatomic location, destruction method used, and post-procedure care. Pre-procedure photographs with a measurement ruler are strongly recommended. Without pathology confirmation and accurate size documentation, claims are frequently denied.

What are the RVUs for CPT code 17274?

CPT 17274 has total RVUs of 7.37, consisting of 2.64 work RVU, 4.45 practice expense RVU (non-facility), 2.15 practice expense RVU (facility), and 0.28 malpractice RVU. These values are from the CMS 2025 Medicare Physician Fee Schedule.

Does CPT 17274 require prior authorization from insurance?

Prior authorization requirements vary by payer and plan. Medicare typically does not require prior authorization for 17274, but Medicare Advantage plans often do. Commercial payers increasingly require prior authorization for destruction procedures, especially for multiple lesions or larger sizes. Always verify with the specific payer before scheduling to avoid payment delays or denials.