CPT 17284Surgery

Dstr mal ls f/e/e/n/l/m3.1-4

CPT 17284 covers the destruction (removal by burning, freezing, or other methods) of a cancerous skin lesion on the face, ears, eyelids, nose, lips, or mucous membranes that measures between 3.1 and 4.0 centimeters in diameter.

Showing rates for

National Average

Base Medicare rate

$269.12

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

3.2

PE RVU (NF)

4.78

MP RVU

0.34

Total RVU

8.32

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

NCCI bundling edits

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Billing tips

Accurately measure and document lesion size in centimeters before destruction; photo documentation strongly recommended
Impact: Incorrect size documentation can result in downcoding to 17283 (2.1-3.0 cm, pays $218.61 non-facility), a loss of $50.51 per claim
Specify exact anatomical location within the qualifying areas (face, ears, eyelids, nose, lips, mucous membranes) in documentation
Impact: Non-qualifying locations code to 17273-17276 series which reimburse $95.71-$218.61, potential loss of $50-$173 per claim
Bill in non-facility setting when possible to capture full $269.12 reimbursement versus $194.08 facility rate
Impact: Setting selection creates $75.04 difference per procedure (27.9% higher reimbursement in office)
Verify pathology report confirms malignancy before billing; benign lesion destruction codes to 17000-17004 series
Impact: Billing malignant code without pathology confirmation risks fraud allegations and potential recoupment of the entire $269.12
When destroying multiple lesions, bill the largest lesion first with 17284, then additional lesions with appropriate codes and modifier 59
Impact: Proper sequencing and modifier use prevents bundling denials and maximizes reimbursement for multi-lesion sessions
Do not bill same-day pathology interpretation (88305) separately; this bundles with destruction per NCCI edits
Impact: Attempting to unbundle results in denial and delays payment; combined service already reflected in $269.12 rate

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 17284 in 2025?

The 2025 Medicare national average reimbursement is $269.12 for non-facility settings and $194.08 for facility settings. The total RVU is 8.32 (3.2 work RVU, 4.78 non-facility PE RVU, 2.46 facility PE RVU, and 0.34 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 17284 and 17283?

CPT 17284 is for malignant lesion destruction measuring 3.1 to 4.0 cm, while 17283 covers lesions 2.1 to 3.0 cm. The size difference results in a $50.51 reimbursement difference ($269.12 vs $218.61 non-facility). Both require the lesion to be on face, ears, eyelids, nose, lips, or mucous membranes.

Can CPT 17284 be billed with an E/M code on the same day?

Yes, but only with modifier 25 appended to the E/M code, and only when a separately identifiable evaluation and management service is performed and documented beyond the decision for destruction. Documentation must clearly show the E/M addressed a distinct problem or was significant and separate from the pre-procedure assessment.

Does CPT 17284 require pathology confirmation before billing?

Yes, billing 17284 requires documentation of malignancy, typically from a prior biopsy pathology report. Clinical diagnosis alone is rarely sufficient for payer acceptance. The pathology report should confirm basal cell carcinoma, squamous cell carcinoma, melanoma, or other malignant diagnosis before destruction is performed.

What anatomical locations qualify for CPT 17284?

CPT 17284 is restricted to malignant lesions on the face, ears, eyelids, nose, lips, and mucous membranes only. Lesions on the trunk, arms, legs, hands, feet, neck, or scalp use different code ranges (17273-17276) with lower reimbursement regardless of size.

How many times can CPT 17284 be billed per patient per year?

There is no specific annual frequency limit for CPT 17284 in Medicare guidelines, as it depends on medical necessity and the number of distinct malignant lesions requiring treatment. However, frequent billing may trigger audits requiring documentation of separate lesions, distinct anatomical sites, and pathology confirmation for each occurrence.

What is the global period for CPT 17284?

CPT 17284 carries a 10-day global period. This means all routine follow-up care related to the destruction within 10 days post-procedure is included in the reimbursement. Any significant complications, unrelated problems, or separately identifiable services during this period require modifier 24 (for E/M) or appropriate surgical modifiers with clear documentation.