Summary & Overview
CPT 17004: Destruction of 15 or More Benign or Premalignant Skin Lesions
CPT code 17004 represents the destruction of 15 or more benign or premalignant skin lesions, most commonly actinic keratoses, using methods such as laser, electrosurgery, cryosurgery, chemosurgery, or surgical curettement. This code is significant in dermatology, as it addresses the need for efficient treatment of multiple lesions in a single session, which is frequently encountered in clinical practice. The procedure is typically performed in an office setting by dermatologists and procedural dermatology specialists.
This publication provides a comprehensive overview of CPT code 17004, including its clinical context, billing benchmarks, and recent policy updates. Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will gain insights into payer coverage, coding nuances, and the role of this code in dermatology practice. The summary also highlights related codes for destruction of fewer lesions, offering a broader perspective on procedural coding for skin lesion management. The information is designed to support healthcare professionals, administrators, and policy analysts in understanding national trends and requirements for this dermatology procedure.
CPT Code Overview
CPT code 17004 is used to report the destruction of all benign or premalignant skin lesions, such as actinic keratoses, when 15 or more lesions are treated during a single session. This procedure may involve various methods, including laser surgery, electrosurgery, cryosurgery, chemosurgery, or surgical curettement. It is classified as a surgical dermatology procedure within the integumentary system. The typical site of service for this code is the office setting (Place of Service 11), where dermatologists and procedural dermatology physicians commonly perform these treatments.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult presenting to a dermatology office with multiple areas of rough, scaly skin lesions diagnosed as actinic keratoses. The provider evaluates the patient and determines that 15 or more lesions require destruction due to their premalignant nature. The procedure is performed in the office setting using methods such as cryosurgery, electrosurgery, laser surgery, chemosurgery, or surgical curettement. The workflow includes lesion identification, documentation, informed consent, and destruction of all identified lesions during a single session.
Coding Specifications
-
Modifier
59: Distinct Procedural Service. Used when a procedure or service is distinct or independent from other services performed on the same day. -
Modifier
51: Multiple Procedures. Used when multiple procedures are performed during the same session by the same provider.
| Modifier Code | Description |
|---|---|
59 | Distinct Procedural Service |
51 | Multiple Procedures |
- Associated Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207N00000X | Dermatology Physician |
207ND0101X | MOHS-Micrographic Surgery Physician |
207NS0135X | Procedural Dermatology Physician |
These taxonomies represent providers specializing in dermatology, MOHS surgery, and procedural dermatology.
Related Diagnoses
L57.0: Actinic keratosis- Actinic keratosis is a premalignant skin lesion caused by chronic sun exposure. It is clinically relevant to CPT code
17004as the procedure is performed to destroy these lesions and prevent progression to squamous cell carcinoma.
- Actinic keratosis is a premalignant skin lesion caused by chronic sun exposure. It is clinically relevant to CPT code
Related CPT Codes
-
17000: Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), all benign or premalignant lesions; first lesion- Used for destruction of the first lesion. Typically billed when fewer than 15 lesions are treated.
-
17003: Add-on code for destruction of premalignant lesion, second through 14th lesion- Used in conjunction with
17000for each additional lesion (second through fourteenth). Not used alone.
- Used in conjunction with
-
17004: Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), all benign or premalignant lesions; 15 or more lesions- Used when 15 or more lesions are treated in a single session. Supersedes
17000and17003when the lesion count meets criteria.
- Used when 15 or more lesions are treated in a single session. Supersedes
In clinical workflow, 17000 and 17003 are used together for up to 14 lesions. 17004 is used as an alternative when treating 15 or more lesions in one session.
National Reimbursement Benchmarks
Medicare's national mean rate for CPT 17004 is $168.41, while the average commercial benchmark (BUCA) is slightly higher at $177.27. Among individual commercial payers, UnitedHealth Group and Cigna report the highest mean rates, at $237.83 and $224.95 respectively, with Aetna at the lower end among commercial payers.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare shows the tightest range ($18.00), indicating more consistent reimbursement, while UnitedHealth Group and Cigna exhibit the widest ranges ($130.96 and $129.00 respectively), reflecting greater variability in commercial rates. Blue Cross Blue Shield and Aetna have moderate dispersion, and BUCA's range is $94.05.
The table and chart below present the full breakdown of national benchmarks for each payer, including mean rates and percentile values.
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