CPT 24075Surgery

Exc arm/elbow les sc < 3 cm

CPT code 24075 covers the surgical removal of a subcutaneous (beneath the skin but above the muscle) lesion from the arm or elbow area when the lesion is smaller than 3 centimeters in diameter. This includes removing growths like lipomas, cysts, or benign tumors through a minor surgical procedure.

Showing rates for

National Average

Base Medicare rate

$513.99

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

4.24

PE RVU (NF)

10.77

MP RVU

0.88

Total RVU

15.89

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

NCCI bundling edits

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Billing tips

Verify and document exact lesion size measurement (in centimeters) in operative report; if lesion measures ≥3cm, code 24076 applies with non-facility rate of $834.41, representing a $320.42 increase
Impact: $320.42 additional payment for accurate sizing when lesion is ≥3cm; downcoding from incorrect size documentation results in substantial underpayment
Distinguish subcutaneous depth from intradermal/dermal excisions; skin lesions should be coded 11400-11406 series (pays $231.06-$428.76) while subfascial/intramuscular uses 24077-24079 (pays $1,318.59-$2,079.58)
Impact: Using correct depth-specific code prevents $185-$1,565 payment variance; operative note must clearly document anatomical layer dissection
Submit clean claims with anatomical location clearly specified as arm or elbow region in both ICD-10 diagnosis code and operative note; payers frequently deny when location ambiguity exists
Impact: Reduces initial denial rate by 30-40%; clean claim processing achieves payment in 14-21 days versus 45-90 days for appeals
Bill non-facility (office/ASC) rate whenever possible as it pays $185.67 more than facility rate; verify place of service code (11 for office, 22 for outpatient hospital, 24 for ASC)
Impact: $185.67 per procedure difference between settings; performing 10 procedures monthly in office versus hospital outpatient generates $22,280 additional annual revenue
When excising multiple separate lesions, bill each excision separately with modifier 59 and document distinct anatomical locations; bundling multiple excisions under single code loses significant reimbursement
Impact: Second lesion excision with modifier 51 still captures approximately $256.99 versus $0 if not separately coded; three lesions could generate $1,027.97 total

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 24075 in 2025?

Medicare pays $513.99 for CPT 24075 in non-facility settings and $328.32 in facility settings based on the 2025 national average rates. The non-facility rate applies when performed in physician offices or ambulatory surgery centers owned by the physician, while the facility rate applies in hospital outpatient departments where the facility receives separate payment.

What is the difference between CPT 24075 and 24076?

CPT 24075 is for excision of subcutaneous arm/elbow lesions less than 3 cm, while 24076 covers lesions 3 cm or greater. This size distinction is critical as 24076 reimburses at $834.41 non-facility compared to 24075's $513.99, making accurate measurement documentation essential for proper coding and reimbursement.

Can I bill CPT 24075 with an E/M service on the same day?

Yes, you can bill an E/M service with CPT 24075 on the same day if the evaluation and management service is significant, separately identifiable, and beyond the usual pre-operative assessment. Append modifier 25 to the E/M code and ensure documentation clearly shows the distinct nature of the E/M service, such as evaluation of unrelated conditions or comprehensive initial assessment leading to the surgical decision.

What documentation is required to prevent denials for CPT 24075?

Required documentation includes exact lesion size in centimeters, specific anatomical location with laterality, clear statement that lesion is subcutaneous (not dermal or intramuscular), medical necessity justification, detailed operative technique, and pathology confirmation. The operative report must explicitly describe dissection through the subcutaneous layer and document measurements to support code selection.

How many RVUs is CPT code 24075 worth in 2025?

CPT 24075 has a total of 15.89 RVUs in 2025, consisting of 4.24 work RVUs, 10.77 non-facility practice expense RVUs (5.03 facility PE RVUs), and 0.88 malpractice RVUs. These RVUs multiplied by the 2025 conversion factor of 32.3465 determine the Medicare payment rates.

What diagnosis codes support medical necessity for CPT 24075?

Common supporting diagnoses include lipoma of upper limb (D17.2), benign neoplasm of connective tissue of upper limb (D21.1), epidermal cyst (L72.0), other specified soft tissue disorders (M79.89), and localized swelling/mass/lump of upper limb (R22.3). Diagnosis codes indicating pain, functional impairment, rapid growth, or diagnostic uncertainty strengthen medical necessity, while purely cosmetic indications risk denial.

Can CPT 24075 be billed bilaterally or for multiple lesions?

Yes, for bilateral excisions on both arms during the same session, use modifier 50 which typically pays 150% of the single procedure rate. For multiple separate lesions on the same or different arms, code each excision separately using modifier 59 on secondary procedures to prevent bundling, with the second and subsequent excisions subject to multiple procedure reduction (typically 50% using modifier 51).