Summary & Overview
CPT 10061: Incision and Drainage of Complicated or Multiple Abscesses
CPT code 10061 is a nationally recognized billing code for the incision and drainage of complicated or multiple abscesses in the skin or soft tissue. This procedure is essential for managing severe infections that cannot be resolved with simple drainage, addressing conditions such as carbuncles, suppurative hidradenitis, and multifocal abscesses. The code is widely used across physician offices and outpatient hospital settings, reflecting its importance in both primary care and surgical specialties.
Major payers including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare provide coverage for services billed under CPT code 10061. The publication offers a comprehensive overview of payer policies, clinical benchmarks, and recent policy updates relevant to this procedure. Readers will gain insight into the clinical context of the code, typical sites of service, and how it fits within broader surgical and dermatological care. The analysis also highlights related codes and modifiers, supporting accurate billing and compliance.
This summary serves as a resource for understanding the national landscape of CPT code 10061, including payer coverage, clinical indications, and procedural context. It is designed for healthcare professionals, policy analysts, and billing specialists seeking up-to-date information on surgical management of complicated skin and soft tissue abscesses.
CPT Code Overview
CPT code 10061 describes the incision and drainage of abscesses that are considered complicated or involve multiple sites. This procedure is performed to treat conditions such as carbuncles, suppurative hidradenitis, cutaneous or subcutaneous abscesses, cysts, furuncles, or paronychia when the infection is extensive or multifocal. The service is classified as Surgical – Skin/Soft Tissue and is typically provided in a physician’s office (POS 11) or an outpatient hospital setting (POS 19/22). This code is used when the complexity or number of abscesses requires a more involved surgical approach than simple incision and drainage.
Clinical & Coding Specifications
Clinical Context
A patient presents to a physician's office or outpatient hospital with a complicated or multiple skin or soft tissue abscesses, such as carbuncles, suppurative hidradenitis, or pilonidal cysts with abscess. The abscesses may be located in various anatomical regions, including the abdomen, pelvis, breast, salivary glands, or genital area. The provider evaluates the patient, determines the need for surgical intervention, and performs an incision and drainage procedure to evacuate pus and relieve infection. The complexity may involve multiple abscesses, deep tissue involvement, or the need for extensive drainage. The procedure is typically performed by a surgery physician, family medicine physician, or internal medicine physician in an outpatient setting.
Coding Specifications
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Modifiers:
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Modifier
51(Multiple Procedures): Used when more than one procedure is performed during the same session by the same provider. Modifier51indicates that the procedure is part of a group of procedures and may affect reimbursement. -
Modifier
59(Distinct Procedural Service): Used to indicate that a procedure or service is distinct or independent from other services performed on the same day. Modifier59is applied when procedures are not normally reported together but are appropriate due to clinical circumstances.
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
208600000X | Surgery Physician |
207Q00000X | Family Medicine Physician |
207R00000X | Internal Medicine Physician |
These taxonomies represent providers who commonly perform incision and drainage of complicated or multiple abscesses.
Related Diagnoses
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L05.91– Unspecified acute pilonidal cyst with abscess- Relevant for patients presenting with acute pilonidal cysts complicated by abscess formation, often requiring incision and drainage.
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L05.92– Chronic pilonidal cyst with abscess- Indicates chronic pilonidal disease with abscess, which may necessitate repeated or complex drainage procedures.
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K11.3– Abscess of salivary gland and ducts- Applies to abscesses in the salivary glands or ducts, which may require surgical drainage.
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K68.12– Psoas abscess- Used for deep-seated abscesses in the psoas muscle, often requiring surgical intervention.
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K68.19– Other specified abscess of abdomen and pelvis- Covers abscesses in abdominal or pelvic regions not otherwise specified, relevant for incision and drainage procedures.
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K68.3– Abscess of retroperitoneal space- Indicates abscesses in the retroperitoneal area, which may be managed surgically.
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K75.0– Abscess of liver- Used for hepatic abscesses requiring drainage.
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N60.01– Acute abscess of right breast- Relevant for patients with acute breast abscesses, often managed by incision and drainage.
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N60.02– Acute abscess of left breast- Applies to acute abscesses in the left breast, requiring similar management.
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N83.201– Unspecified ovarian abscess- Used for ovarian abscesses where the laterality is not specified.
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N83.202– Ovarian abscess, bilateral- Indicates bilateral ovarian abscesses, which may require complex drainage.
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N83.291– Unspecified fallopian tube abscess- Applies to abscesses in the fallopian tubes without specified laterality.
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N83.292– Fallopian tube abscess, bilateral- Used for bilateral fallopian tube abscesses, often requiring surgical management.
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N88.8– Other specified noninflammatory disorders of cervix- May be relevant if abscess formation is present in the cervix.
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N89.8– Other specified noninflammatory disorders of vagina- Used when abscesses or related disorders occur in the vaginal area.
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N90.7– Other specified disorders of vulva and perineum- Applies to abscesses or other disorders in the vulva and perineum, which may require incision and drainage.
Each diagnosis code represents a clinical scenario where incision and drainage of a complicated or multiple abscess may be indicated.
Related CPT Codes
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10060– Incision and drainage of abscess; simple or single- Used for less complex or single abscesses. It is an alternative to
10061when the abscess is not complicated or multiple.
- Used for less complex or single abscesses. It is an alternative to
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10160– Puncture aspiration of abscess, hematoma, bulla, or cyst- Used when the abscess or cyst is managed by aspiration rather than incision and drainage. May be used as an alternative or in conjunction with
10061depending on clinical need.
- Used when the abscess or cyst is managed by aspiration rather than incision and drainage. May be used as an alternative or in conjunction with
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11042– Debridement, subcutaneous tissue- Used when debridement of subcutaneous tissue is required, often in cases where infection or necrosis accompanies the abscess. May be performed in addition to
10061if tissue removal is necessary.
- Used when debridement of subcutaneous tissue is required, often in cases where infection or necrosis accompanies the abscess. May be performed in addition to
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12001– Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities- Used when wound repair is needed after incision and drainage. May be reported with
10061if closure of the surgical site is performed.
- Used when wound repair is needed after incision and drainage. May be reported with
These codes are commonly used together or as alternatives based on the complexity and clinical presentation of the abscess.
National Reimbursement Benchmarks
For CPT code 10061, the national mean rate for Medicare is $226.92, while the average commercial benchmark (BUCA) is higher at $251.42. Among the major commercial payers, UnitedHealth Group and Cigna have the highest mean rates, both exceeding $330, while Aetna is notably lower at $205.59.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare shows the tightest range at $21.00, indicating relatively consistent reimbursement rates. In contrast, UnitedHealth Group and Cigna exhibit the widest dispersions, with ranges of $207.67 and $191.00 respectively, reflecting greater variability in commercial payments.
The table and chart below present the full breakdown of national benchmarks for each payer, including mean rates and percentile values.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.