CPT 17286Surgery

Dstr mal ls f/e/e/n/l/m>4.0

CPT 17286 covers the destruction of a malignant (cancerous) skin lesion on the face, ears, eyelids, nose, lips, or mucous membranes when the lesion is larger than 4.0 centimeters. This typically involves using methods like laser, cryotherapy, or electrosurgery to remove the cancerous tissue.

Showing rates for

National Average

Base Medicare rate

$347.72

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

4.48

PE RVU (NF)

5.77

MP RVU

0.5

Total RVU

10.75

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

NCCI bundling edits

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Billing tips

Always measure and document the lesion diameter in centimeters before destruction and photograph when possible. The difference between 3.9 cm (17284) and 4.1 cm (17286) is $67.62 in non-facility settings.
Impact: $67.62 revenue difference per 0.2 cm threshold; exact measurement documentation prevents downcoding
Bill facility vs. non-facility based on actual place of service. Non-facility (office) pays $347.72 vs. facility (hospital outpatient/ASC) pays $264.92.
Impact: $82.80 difference (23.8% higher in non-facility); verify POS code matches actual location
Append modifier 59 or XS when billing multiple destruction codes on the same day for separate lesions. Without proper modifier, secondary destructions will bundle and deny.
Impact: Can recover $264.92-$347.72 per additional lesion; improper modifier use is a top denial reason
Document the specific anatomical location within the face/ears/eyelids/nose/lips/mucous membrane area. Generic 'face' documentation increases audit risk for this high-paying code.
Impact: Reduces audit risk and potential recoupment; specific anatomical documentation supports medical necessity
Obtain pathology confirmation of malignancy prior to destruction when possible. Medicare and commercial payers increasingly require biopsy proof before destructive treatment of 'malignant' lesions.
Impact: Prevents denial and potential fraud allegations; lacking pathology can result in 100% denial ($347.72 loss)
Do not bill 17286 with excision codes (11640-11646) for the same lesion. Choose either destruction or excision, not both. Billing both is considered unbundling.

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 17286 in 2025?

The 2025 Medicare national average reimbursement for CPT 17286 is $347.72 in non-facility settings (physician office) and $264.92 in facility settings (hospital outpatient or ASC). These rates are based on the 2025 Medicare Physician Fee Schedule with a conversion factor of 32.3465.

What size lesion qualifies for CPT 17286 vs 17284?

CPT 17286 requires lesion size greater than 4.0 cm in diameter. Lesions 3.1-4.0 cm use CPT 17284 instead. Accurate measurement documentation is critical as the payment difference is $67.62 in non-facility settings. Always measure in centimeters and document the greatest diameter before destruction.

Can CPT 17286 be billed with an E/M service on the same day?

Yes, but only if a separate, significant, and identifiable evaluation and management service is performed and documented beyond the typical pre-procedure assessment. Append modifier 25 to the E/M code and ensure documentation clearly shows the distinct nature of the E/M service (e.g., management of unrelated conditions, comprehensive assessment beyond lesion evaluation).

What anatomical locations qualify for CPT 17286?

CPT 17286 is specific to malignant lesions on the face, ears, eyelids, nose, lips, or mucous membranes. Lesions on the trunk, arms, legs, hands, feet, or scalp use different CPT codes (17260-17266 series). Documentation must clearly specify the anatomical location within these approved areas.

Is pathology confirmation required before billing CPT 17286?

While not absolutely required by CPT definition, Medicare and most commercial payers expect biopsy pathology confirmation of malignancy before destructive treatment. Billing 17286 without pathology proof significantly increases denial and audit risk. If biopsy was not performed, document compelling medical necessity reasons in the operative note.

How many RVUs is CPT 17286 worth in 2025?

CPT 17286 has a total of 10.75 RVUs in 2025, consisting of 4.48 work RVUs, 5.77 practice expense RVUs (non-facility), 3.21 practice expense RVUs (facility), and 0.50 malpractice RVUs. This is based on the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024.

Can I bill CPT 17286 multiple times on the same day for multiple lesions?

Generally no. CPT 17286 is typically billed once per session. If multiple large malignant lesions are destroyed on the same date, use 17286 for the first/largest lesion and append modifier 59 to additional destruction codes only if the lesions are at completely separate anatomical sites. Most payers limit one destruction code per anatomical area per date. Review payer-specific policies carefully as bundling rules vary.