CPT 17276Surgery

Dstr mal les s/n/h/f/g >4.0

CPT 17276 covers the destruction of a malignant (cancerous) skin lesion larger than 4.0 cm on the scalp, neck, hands, feet, or genitalia using methods like laser, freezing, or electrosurgery. This is for larger cancerous growths on particularly sensitive or visible areas of the body.

Showing rates for

National Average

Base Medicare rate

$276.24

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

3.25

PE RVU (NF)

4.93

MP RVU

0.36

Total RVU

8.54

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

NCCI bundling edits

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Billing tips

Measure and document exact lesion diameter in millimeters or centimeters at widest point before destruction; threshold is precisely >4.0 cm, and under-documentation may force downcoding to 17274
Impact: Difference between 17274 ($215.91 non-facility) and 17276 ($276.24 non-facility) is $60.33 per lesion
Verify anatomic location qualifies for s/n/h/f/g designation (scalp, neck, hands, feet, genitalia); trunk or extremity lesions require different code series (17260-17266) with different payment
Impact: Wrong anatomic series can result in $50-150 payment variance and automatic denials
Bill only ONE code from the 17270-17276 series per session regardless of number of lesions in s/n/h/f/g locations; first lesion uses size-appropriate code, additional lesions billed with 17270
Impact: Billing multiple codes from same series triggers bundling edits and automatic denial; proper sequencing with 17270 for additional lesions maximizes legitimate reimbursement
Document destruction method specifically (cryotherapy, electrodesiccation, laser type) and margin treatment; vague documentation increases audit risk
Impact: Reduces audit recoupment risk; MAC audits for dermatology destruction codes have 15-25% error rate nationally
For facility billing, verify pathology confirmation of malignancy is in medical record before date of service; destruction of 'suspected' malignancy may deny
Impact: $79.25 difference between facility and non-facility rate emphasizes importance of proper site-of-service coding
When billing with E/M using modifier 25, document the separately identifiable service in distinct section of note; reference specific evaluation beyond lesion being destroyed

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Frequently asked questions

What is the Medicare reimbursement for CPT 17276 in 2025?

Medicare pays $276.24 for CPT 17276 in non-facility settings and $196.99 in facility settings based on the 2025 national average rates. Actual payment may vary by geographic locality based on GPCI adjustments.

How many times can you bill CPT 17276 per session?

CPT 17276 can only be billed once per session regardless of how many large malignant lesions are destroyed on s/n/h/f/g locations. Additional malignant lesions on these same anatomic sites during the same session should be reported with CPT 17270.

What size lesion qualifies for CPT 17276?

CPT 17276 requires the malignant lesion to be greater than 4.0 cm in diameter at the widest point. Lesions measuring exactly 4.0 cm or smaller should be coded with 17274 (3.1-4.0 cm) or smaller size-tier codes.

What anatomic locations are covered by CPT 17276?

CPT 17276 is specific to malignant lesions on the scalp, neck, hands, feet, or genitalia (s/n/h/f/g). Lesions on the trunk, arms, legs, or face require different CPT codes from the 17260-17266 series.

Can you bill an E/M with CPT 17276 on the same day?

Yes, you can bill an E/M service with modifier 25 on the same day as CPT 17276 if the E/M represents a separately identifiable service beyond the decision to perform the destruction. Documentation must clearly show the distinct evaluation, such as assessment of other lesions or medical conditions.

What is the difference between CPT 17276 and 17274?

The difference is lesion size: CPT 17274 covers malignant lesions 3.1-4.0 cm, while 17276 covers lesions greater than 4.0 cm, both on s/n/h/f/g locations. The 2025 Medicare payment difference is $60.33 ($276.24 for 17276 vs $215.91 for 17274 non-facility).

Does CPT 17276 require pathology confirmation before billing?

Yes, Medicare and most payers require documented pathology confirmation of malignancy before or concurrent with the destruction procedure. Destroying a 'suspected' or 'probable' malignancy without tissue confirmation typically results in claim denial or requirement to use a different code.