CPT 17281Surgery

Dstr mal ls f/e/e/n/l/m .6-1

CPT 17281 covers the destruction of a malignant (cancerous) skin lesion measuring between 0.6 and 1.0 centimeters on the face, ears, eyelids, nose, lips, or mucous membranes. This typically involves methods like cryotherapy, electrosurgery, or laser treatment to remove the lesion.

Showing rates for

National Average

Base Medicare rate

$174.99

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

1.77

PE RVU (NF)

3.46

MP RVU

0.18

Total RVU

5.41

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

NCCI bundling edits

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Billing tips

Measure and document lesion diameter precisely before destruction, including margin measurement if applicable, as movement from 0.5 cm to 0.6 cm changes the code from 17280 to 17281
Impact: Correct code selection difference: 17280 pays $142.39 vs 17281 at $174.99 non-facility = $32.60 difference per lesion
Document the specific anatomic location within high-risk areas (face, ears, eyelids, nose, lips, mucous membranes) as codes 17260-17266 apply to other body areas with different reimbursement
Impact: Incorrect location coding could result in downcoding to lower-paying trunk/extremity codes (17260-17266 series), losing approximately $30-50 per procedure
For multiple lesions destroyed in the same session, bill 17281 for the first lesion and add-on code 17282 for each additional lesion in the 0.6-1.0 cm range rather than repeating 17281
Impact: 17282 add-on code pays approximately $98-115 and prevents modifier complications; billing multiple 17281 codes may trigger denials or require extensive documentation
Verify pathology confirmation of malignancy before billing; presumptive treatment of suspected malignancy without biopsy should use benign lesion destruction codes (17000-17004) even if clinical suspicion is high
Impact: Billing malignant destruction without pathology proof risks audits, recoupment, and potential fraud investigation; benign codes pay $92-115 less per lesion but are compliant
Understand facility vs non-facility settings: physician practice pays $174.99 while hospital outpatient department pays physician only $115.80, with facility fee billed separately by hospital
Impact: Site of service decision affects physician revenue by $59.19 per procedure; non-facility settings yield 51% higher physician reimbursement

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Frequently asked questions

What is the Medicare reimbursement for CPT code 17281 in 2025?

Medicare pays $174.99 for CPT 17281 in non-facility settings (physician office) and $115.80 in facility settings (hospital outpatient department) based on the 2025 national average rates. Actual payment may vary by geographic locality based on the GPCI adjustment factors applied to your region.

How many RVUs is CPT code 17281 worth?

CPT 17281 has a total of 5.41 RVUs for 2025, broken down as: 1.77 work RVUs, 3.46 non-facility practice expense RVUs (1.63 facility PE RVUs), and 0.18 malpractice RVUs. These RVU values are multiplied by the 2025 conversion factor of 32.3465 to determine payment.

What size lesion does CPT 17281 cover?

CPT 17281 applies to malignant lesions measuring between 0.6 cm and 1.0 cm in diameter. Lesions 0.5 cm or smaller use code 17280, while lesions 1.1-2.0 cm use code 17282 (as an add-on) or different primary codes depending on whether it's the first lesion treated.

Can you bill CPT 17281 for multiple lesions on the same day?

Yes, but coding differs by lesion. Bill 17281 for the first lesion in the 0.6-1.0 cm size range, then use add-on code 17282 for each additional lesion in that same size category destroyed during the same session. Do not repeat 17281 multiple times; 17282 is specifically designed as the add-on code.

What body locations are covered under CPT 17281?

CPT 17281 is specific to high-risk anatomic areas: face, ears, eyelids, nose, lips, and mucous membranes. For malignant lesion destruction on the trunk, arms, legs, hands, feet, or genitalia, use the different code series 17260-17266 instead, which have different reimbursement rates.

Do you need a biopsy before billing CPT 17281?

Yes, pathology confirmation of malignancy is required to bill 17281. You can obtain biopsy before destruction or submit the entire destroyed specimen for pathology, but documentation must prove malignancy. Without pathology confirmation, you must use benign lesion destruction codes 17000-17004 even if clinical suspicion for malignancy is high.

What is the difference between CPT 17281 and 17282?

CPT 17281 is the primary code for destroying the first malignant lesion measuring 0.6-1.0 cm on face/ears/eyelids/nose/lips/mucous membranes. CPT 17282 is an add-on code used for each additional lesion in that same size range destroyed during the same session. 17282 cannot be billed alone and must accompany a primary destruction code like 17281.