CPT 22902Surgery

Exc abd les sc < 3 cm

CPT 22902 covers the surgical removal of a subcutaneous (under the skin) lesion from the abdomen that is less than 3 centimeters in diameter. This is typically a benign growth, cyst, or lipoma that requires excision beneath the skin surface.

Showing rates for

National Average

Base Medicare rate

$460.29

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

4.42

PE RVU (NF)

8.78

MP RVU

1.03

Total RVU

14.23

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Verify and document exact lesion size measurement in operative report; lesions ≥3 cm require different code (22903) with significantly higher reimbursement
Impact: Upcoding to 22903 when appropriate increases reimbursement by approximately $150-200; undercoding costs significant revenue
Clearly differentiate subcutaneous excision from simple skin lesion removal (11400-11406 series) by documenting depth of dissection below dermis through subcutaneous tissue
Impact: Prevents downcoding from $460.29 to $150-250 range for simple skin lesion codes; documentation of layered closure supports complexity
Bill in non-facility setting when performed in office-based surgical suite to capture $129.06 higher reimbursement ($460.29 vs $331.23)
Impact: 29% revenue increase for non-facility setting; ensure compliance with office surgery requirements and documentation
When multiple lesions excised, list largest/most complex lesion first without modifier, then apply modifier 51 to additional lesions to maximize reimbursement
Impact: First lesion receives 100% payment, subsequent at 50%; proper sequencing can impact total payment by 10-15%
Submit pathology report with claim for lesions with potential malignancy concern to support medical necessity and reduce audit risk
Impact: Reduces denial rate by 15-25% when medical necessity questioned; essential for cosmetic vs medical necessity differentiation
Do not unbundle with intermediate or complex repair codes (12031-13153); closure is included in 22902 base payment
Prevents denials and recoupment; repair bundling violations can trigger broader audits

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 22902?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is the Medicare reimbursement rate for CPT code 22902 in 2025?

Medicare pays $460.29 for CPT 22902 in non-facility settings and $331.23 in facility settings based on the 2025 Physician Fee Schedule. The non-facility rate is higher because it includes overhead costs for equipment and supplies when performed in an office setting.

What is the difference between CPT 22902 and 11406 for abdominal lesion removal?

CPT 22902 is for subcutaneous lesion excision requiring dissection below the dermis through fat tissue with layered closure, while 11406 is for simple excision of benign skin lesions involving only skin and dermis. Code 22902 has higher reimbursement ($460.29 vs approximately $250) due to greater complexity and depth of dissection.

How many RVUs is CPT code 22902 worth in 2025?

CPT 22902 has a total of 14.23 RVUs in 2025, consisting of 4.42 work RVUs, 8.78 non-facility practice expense RVUs (4.79 facility PE RVUs), and 1.03 malpractice RVUs. This moderate RVU value reflects the procedural complexity and time required.

Can CPT 22902 be billed bilaterally with modifier 50?

Yes, if subcutaneous lesions are excised from both the left and right sides of the abdomen during the same operative session, modifier 50 can be appended. Documentation must clearly show separate lesions on each side. Bilateral billing typically results in 150% of the base reimbursement rate.

What size lesion qualifies for CPT 22902 versus 22903?

CPT 22902 is for abdominal subcutaneous lesions less than 3 cm in diameter, while CPT 22903 is for lesions 3 cm or greater. The measurement should be taken of the actual lesion before excision, not the specimen after removal. Accurate size documentation is critical as 22903 reimburses approximately $150-200 more.

Is pathology required when billing CPT 22902?

While not absolutely required by CPT definition, submitting excised tissue to pathology is standard of care and strongly recommended. Pathology reports support medical necessity, confirm diagnosis, rule out malignancy, and significantly reduce denial rates for cosmetic vs medically necessary determinations. Most payers expect pathology for subcutaneous excisions.

Can I bill an E/M code on the same day as CPT 22902?

You can bill a same-day E/M with modifier 25 only if a significant, separately identifiable evaluation and management service was provided beyond the normal pre-operative assessment. For scheduled procedures, do not bill E/M unless an unrelated problem was addressed. Documentation must clearly support the separate service to avoid denials.