{"id":180955,"date":"2026-08-18T07:21:59","date_gmt":"2026-08-18T07:21:59","guid":{"rendered":"https:\/\/pabau.com\/?p=180955"},"modified":"2026-08-18T13:58:17","modified_gmt":"2026-08-18T13:58:17","slug":"cpt-code-11462","status":"publish","type":"post","link":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-11462\/","title":{"rendered":"CPT Code 11462: Inguinal hidradenitis excision billing guide"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"CPT Code 11462: Excision of skin and subcutaneous tissue for hidradenitis, inguinal\",\"description\":\"CPT code 11462 covers excision of skin and subcutaneous tissue for hidradenitis suppurativa (L73.2) in the inguinal region with simple or intermediate repair. Covers 2026 Medicare rates, modifiers, ICD-10 pairings, and documentation requirements.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/cpt-code-11462\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-08-10\",\"dateModified\":\"2026-08-18\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>CPT code 11462 covers inguinal hidradenitis excision closed with simple or intermediate repair.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>A complex closure at the same site is 11463, and that one note detail decides the code.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>ICD-10-CM L73.2 is the primary diagnosis code that supports medical necessity for 11462.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>The 2026 Medicare national rate is about $450 non-facility and about $243 in a facility.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>No national CMS article covers the 11450-11471 family, so read your own MAC&#8217;s LCD.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-what-cpt-code-11462-covers\" class=\"wp-block-heading\">What CPT code 11462 covers<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT code 11462 covers excision of skin and subcutaneous tissue for hidradenitis suppurativa in the inguinal region. Specifically, the wound must be closed with simple or intermediate repair. Otherwise, a complex closure at the same site is reported with 11463.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-11462\/automate-claims-through-healthcode.webp\" alt=\"Claims list inside Pabau's claims management dashboard\"\/><figcaption class=\"wp-element-caption\"><em>Pabau submits and tracks each surgical claim from one screen, so an 11462 denial surfaces while the appeal window is still open.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Two details in the operative note decide the code: the first is the anatomical site, and the second is the closure type. In practice, <a href=\"https:\/\/pabau.com\/features\/claims-management-software\/\">claims management software<\/a> built for surgical practices flags either one before the claim goes out.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The code is maintained by the American Medical Association (AMA) and sits in the Excision-Benign Lesions section of the CPT code set. Its official description reads: <strong>Excision of skin and subcutaneous tissue for hidradenitis, inguinal; with simple or intermediate repair.<\/strong> Altogether, three elements define its scope.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Condition:<\/strong> Hidradenitis suppurativa (HS), a chronic inflammatory skin disease affecting apocrine-gland-rich areas<\/li>\n\n\n\n<li><strong>Site:<\/strong> Inguinal region (groin) only, which separates it from the axillary codes 11450 and 11451<\/li>\n\n\n\n<li><strong>Repair complexity:<\/strong> Simple or intermediate closure only. Complex repair at the same site is reported with 11463<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">The code sits in the hidradenitis excision family, 11450 through 11471. Within that group, most audit findings come from billing 11462 when the closure was complex. Consequently, a <a href=\"https:\/\/pabau.com\/industry\/dermatology-emr-software\/\">dermatology EMR<\/a> should force a repair-type check before the claim is coded.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"CPT Coding Pitfalls Every Medical Practice Faces\" width=\"800\" height=\"450\" src=\"https:\/\/www.youtube.com\/embed\/vbvV5okdXKg?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 id=\"h-medicare-reimbursement-and-fee-schedule\" class=\"wp-block-heading\">Medicare reimbursement and fee schedule<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Reimbursement for 11462 varies by place of service, geographic location, and the annual CMS update. Accordingly, the figures below are 2026 Medicare national rates. Even so, verify the current amount for your locality with the <a href=\"https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search\/overview\" target=\"_blank\" rel=\"nofollow noopener\">CMS Physician Fee Schedule<\/a>.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Place of service<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">2026 national rate (approx.)<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Notes<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Non-facility (office)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">~$450<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Based on 13.46 total RVUs for the non-facility setting<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Facility (hospital\/ASC)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">~$243<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Based on 7.27 total RVUs. The facility bills separately for overhead<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Geographic adjustment<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Varies by locality<\/td>\n<td style=\"padding:12px 16px;color:#374151\">High-cost metro areas such as New York and San Francisco pay above the national base<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Those national figures come from the code&#8217;s total RVUs multiplied by the 2026 conversion factor. Specifically, 11462 carries 13.46 total RVUs in the non-facility setting and 7.27 in a facility. At a conversion factor near $33.40, that in turn lands at roughly $450 and $243. Even so, check the current components with the FastRVU 2026 RVU lookup before you quote a locality figure.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Commercial contracts commonly pay above the Medicare benchmark for surgical excision codes. The multiplier varies by market and by contract tier, so verify against the payer&#8217;s own fee schedule.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Request a pre-authorization reference number before performing hidradenitis excision. Even when the procedure meets medical necessity criteria, some payers require prior authorization for skin excision codes in the 11450-11471 range. Record the authorization number in the client record and put it on the claim form.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-modifiers-that-apply-to-11462\" class=\"wp-block-heading\">Modifiers that apply to 11462<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Laterality and bilateral billing are the two modifier decisions that come up on almost every 11462 claim. Accordingly, the table below covers the modifiers used most often with this code.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Modifier<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Name<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to use<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Key caution<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">50<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Bilateral procedure<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Hidradenitis excised from both left and right inguinal areas in the same operative session<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Medicare pays 150% of the single procedure rate, not 200%. Verify payer-specific bilateral rules first<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">59<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Distinct procedural service<\/td>\n<td style=\"padding:12px 16px;color:#374151\">When 11462 is performed at an anatomically separate site from another procedure billed on the same date<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Requires clear documentation of a separate site. Never use it to bypass a bundling edit<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">22<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Increased procedural services<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Procedure substantially exceeds the typical work for 11462 (e.g. unusually extensive disease, difficult dissection)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Requires an operative note narrative explaining the extra work. Expect payer review<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">LT \/ RT<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Left side \/ Right side<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Some payers require laterality modifiers instead of or in addition to modifier 50 for bilateral billing<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Check the payer&#8217;s bilateral billing policy. Medicare and commercial payers differ<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">78<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unplanned return to OR<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Patient returns to the operating room during the global period for a complication of the original 11462<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Use it only for a related return. An unrelated procedure in the global period takes modifier 79 instead<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Bilateral hidradenitis excision is where most modifier disputes start. For instance, some payers want two line items, 11462-LT and 11462-RT, rather than one line with modifier 50. Either way, confirm the payer&#8217;s preference in their billing guidelines before you submit. For Medicare specifically, the bilateral adjustment pays 150% of the single rate, not double.<\/p>\n\n\n\n<h2 id=\"h-icd-10-diagnosis-codes-that-support-the-claim\" class=\"wp-block-heading\">ICD-10 diagnosis codes that support the claim<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Every 11462 claim must carry an ICD-10-CM diagnosis code that establishes medical necessity. Indeed, a nonspecific or incorrect diagnosis code is a leading cause of <a href=\"https:\/\/pabau.com\/blog\/denial-codes-in-medical-billing\/\">claim denials<\/a> for this procedure.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">ICD-10-CM code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Use with 11462?<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">L73.2<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Hidradenitis suppurativa<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Primary code; maps directly to the procedure indication<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">L73.8<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Other specified follicular disorders<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Secondary code, used only when the note identifies another follicular condition alongside HS<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">L02.214<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Cutaneous abscess of groin<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Acceptable secondary code when an abscess is documented in the same region. Never a replacement for L73.2<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">L08.0<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Pyoderma<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Use only when the operative note documents pyoderma at the surgical site<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">L73.2 is therefore the correct primary code in virtually all 11462 claims. Even so, do not substitute a broader skin condition code when the record identifies hidradenitis suppurativa. No single national CMS article lists covered diagnoses for the 11450-11471 family, so read your MAC&#8217;s <a href=\"https:\/\/www.cms.gov\/medicare-coverage-database\/search.aspx\" target=\"_blank\" rel=\"nofollow noopener\">Local Coverage Determination<\/a>.<\/p>\n\n\n\n<h2 id=\"h-what-the-operative-note-must-document\" class=\"wp-block-heading\">What the operative note must document<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Post-payment audits for skin excision codes turn on what the operative note says. For that reason, <a href=\"https:\/\/pabau.com\/features\/medical-records-management\/\">electronic client records<\/a> with structured note templates keep the required elements in front of the surgeon. Specifically, the note for 11462 must contain all of the following.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-11462\/detailed-client-records-in-pabau.webp\" alt=\"A client record in Pabau showing treatment history and clinical notes\"\/><figcaption class=\"wp-element-caption\"><em>Pabau keeps the operative note, the anatomical site, and the repair type in one client record, so coding review has everything it needs.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Confirmed diagnosis:<\/strong> Explicit statement that the condition treated is hidradenitis suppurativa, ideally referencing prior clinical or pathological confirmation<\/li>\n\n\n\n<li><strong>Anatomical site specificity:<\/strong> Documentation must state &#8220;inguinal&#8221; or &#8220;groin&#8221; region. Otherwise, unspecified site documentation disqualifies the claim for 11462 and creates audit risk<\/li>\n\n\n\n<li><strong>Description of tissue excised:<\/strong> The operative note must describe the extent of skin and subcutaneous tissue removed, including approximate dimensions<\/li>\n\n\n\n<li><strong>Repair type documented:<\/strong> The surgeon must document whether wound closure was simple, intermediate, or complex. In fact, this single element determines whether 11462 or 11463 is the correct code<\/li>\n\n\n\n<li><strong>Medical necessity justification:<\/strong> Notes should reflect the conservative treatment history (antibiotics, wound care, drainage) that preceded the decision to operate<\/li>\n\n\n\n<li><strong>Pathology report:<\/strong> Sending excised tissue to pathology is not always required. It backs up medical necessity, so it is worth doing for audit protection<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">When the note is written at the time of surgery with these elements built in, coding review verifies rather than reconstructs. That is what produces a <a href=\"https:\/\/pabau.com\/blog\/clean-claim\/\">clean claim<\/a> more often.<\/p>\n\n\n\n<h2 id=\"h-coverage-and-medical-necessity-criteria\" class=\"wp-block-heading\">Coverage and medical necessity criteria<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare covers 11462 when the clinical record supports surgical intervention as medically necessary for hidradenitis suppurativa. Even so, coverage is not automatic: the record must show that conservative management was tried and failed. In addition, Local Coverage Determinations (LCDs) issued by Medicare Administrative Contractors (MACs) may add criteria for your jurisdiction.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">No national coverage article addresses the 11450-11471 family, so your MAC&#8217;s LCD is the document that governs. Criteria differ between contractors, and a requirement one MAC publishes may not appear in another&#8217;s policy.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Retention rules for the underlying records come from state law and the CMS conditions of participation, not from HIPAA. Five to ten years is the common range, so check your own state&#8217;s requirement. That said, <a href=\"https:\/\/pabau.com\/blog\/hipaa-compliance-for-medical-offices\/\">HIPAA documentation practices<\/a> still govern how you store and disclose them.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Covered indication:<\/strong> Active hidradenitis suppurativa with documented failure of conservative management (antibiotics, topical treatments, drainage)<\/li>\n\n\n\n<li><strong>Non-covered indication:<\/strong> Prophylactic or cosmetically motivated excision without documented HS diagnosis and conservative treatment failure<\/li>\n\n\n\n<li><strong>Commercial payer variation:<\/strong> Plans may apply different criteria or require prior authorization. Verify before scheduling the procedure<\/li>\n<\/ul>\n\n\n\n<h2 id=\"h-related-cpt-codes-for-hidradenitis-excision\" class=\"wp-block-heading\">Related CPT codes for hidradenitis excision<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT 11462 belongs to a structured code family organized by anatomical site and repair complexity. Within that family, selecting the wrong code is the most common reason practices face post-payment recoupment requests for hidradenitis procedures.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">CPT code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Site<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Repair type<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Key differentiator<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">11450<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Axillary (armpit)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Simple or intermediate<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Same repair complexity as 11462 but different anatomical site<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">11451<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Axillary (armpit)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Complex<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Axillary site with complex repair. Use it only when the note documents a complex closure<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">11462<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Inguinal (groin)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Simple or intermediate<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The subject of this article<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">11463<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Inguinal (groin)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Complex<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Same inguinal site as 11462, used when the note documents a flap or a graft<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">11470<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Perianal, perineal, or umbilical<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Simple or intermediate<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Different body region; requires documentation of the specific anatomical site<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">11471<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Perianal, perineal, or umbilical<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Complex<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Same region as 11470 with complex repair. The highest complexity code in the family<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The 11462 versus 11463 decision comes down to one documented fact: what type of closure did the surgeon perform? Simple and intermediate repair close the wound with suture layers, whereas complex repair uses advancement flaps, rotation flaps, or skin grafts. Either way, if the note does not state the closure method, neither code holds up in an audit. Likewise, axillary disease follows the same site-and-closure rule under <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-11450\/\">11450<\/a>.<\/p>\n\n\n\n<h2 id=\"h-common-billing-errors-and-how-to-avoid-them\" class=\"wp-block-heading\">Common billing errors and how to avoid them<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Four error patterns account for most 11462 denials and recoupments. Each one starts in the operative note, so the fix belongs in the documentation workflow. In practice, tightening <a href=\"https:\/\/pabau.com\/blog\/medical-billing-compliance\/\">billing compliance<\/a> routines is what prevents them.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Wrong repair type coded:<\/strong> Billing 11462 when the repair was complex (11463) is a specificity error. Indeed, post-payment audits cross-reference operative notes against the billed code. So when the note says &#8220;advancement flap&#8221; but the claim shows 11462, recoupment follows. Fix: add repair-type confirmation as a required field in your post-op coding checklist.<\/li>\n\n\n\n<li><strong>Wrong site selection:<\/strong> Axillary hidradenitis is common, inguinal is less so. As a result, coders unfamiliar with the procedure family occasionally assign 11462 to an axillary case that should be 11450. For that reason, the anatomical site must appear in the operative note, not just in the procedure description. Fix: require the surgeon to circle or type the site verbatim in the operative summary.<\/li>\n\n\n\n<li><strong>Missing or unsupported modifier 50:<\/strong> Modifier 50 goes on the claim without documentation that both sides were excised in the same session. Even so, payers may accept the claim but flag it for audit. Fix: the operative note must state both sites explicitly, and any pre-authorization must cover both sides.<\/li>\n\n\n\n<li><strong>Unbundling the repair:<\/strong> Attempting to bill the wound closure separately from 11462, using the simple and intermediate repair codes 12001-12057. After all, the code description already includes simple or intermediate repair, so billing the closure separately is an unbundling violation. Fix: train coders that repair is bundled into 11462 by definition. Instead, 11463 is an upgrade for a complex closure, not an add-on code.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Practices running a <a href=\"https:\/\/pabau.com\/industry\/plastic-surgery-emr\/\">plastic surgery EMR<\/a> with coding review built in can catch site and modifier mismatches before the claim reaches the clearinghouse. Unbundling, however, is different: it is a coder training issue that no software flags on its own, so it needs a written internal policy. For reference, the <a href=\"https:\/\/www.aapc.com\/codes\/cpt-codes-range\/\" target=\"_blank\" rel=\"nofollow noopener\">AAPC CPT code search<\/a> carries the parenthetical notes and bundling guidance built into the official descriptions.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Run a quarterly audit of 11462 claims against the operative notes. Pull every claim for the code from the prior 90 days. Check that the site and repair type in each note match the billed code. Then confirm the modifier matches the bilateral status recorded. Log every mismatch, because the pattern tells you whether the fix belongs with the surgeon or the coder.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-how-pabau-keeps-11462-documentation-audit-ready\" class=\"wp-block-heading\">How Pabau keeps 11462 documentation audit-ready<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">In most surgical practices the operative note is dictated after the list and coded a day or two later. As a result, the site and the closure type are the two details that go missing in that handoff. Unsurprisingly, they are also the first things a recoupment letter asks about.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practice management software like Pabau moves that check to the point of care. Specifically, custom note templates make the anatomical site and the repair type required fields. The surgeon then records both before the note closes, so coding review reads the note instead of reconstructing it.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pabau&#8217;s claims tools submit and track each claim, so a denial surfaces while the appeal window is still open. In turn, that turns <a href=\"https:\/\/pabau.com\/blog\/denial-management-in-healthcare\/\">denial management<\/a> into a short weekly review rather than a monthly scramble. Importantly, every Pabau subscription includes all of it, with no higher tier to unlock.<\/p>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Reduce claim denials for surgical procedures                <\/h3>\n\n                <p class=\"description\">\n                    Structured note templates capture the site and the repair type at the point of care. Pabau&#8217;s claims tools then submit and track the claim, so an 11462 denial surfaces early.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau claims management dashboard\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 id=\"h-conclusion\" class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Two facts decide whether an 11462 claim survives review: the site must be inguinal, and the closure must be simple or intermediate. Either way, both live in the operative note or nowhere at all.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Fix the note, and the modifier questions mostly answer themselves. For example, a surgeon who writes &#8220;bilateral inguinal, layered closure&#8221; has already chosen the code and justified modifier 50.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Get that habit in place before your next quarterly audit rather than after it. <a href=\"https:\/\/pabau.com\/book-demo\/\">Book a demo<\/a> to see how Pabau structures operative notes so surgical claims go out defensible.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Coding the axillary version of this procedure?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-11450\/\">11450<\/a> covers hidradenitis excision at the axilla with simple or intermediate repair.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Need to know what the payer receives?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/837-file\/\">837 file<\/a> explains the electronic claim format your clearinghouse sends on your behalf.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Posting payments and denials by hand?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/electronic-remittance-advice\/\">Electronic remittance advice<\/a> shows how to read the 835 and reconcile it against the claim.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Not sure how long you have to file?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/timely-filing-limits\/\">Timely filing limits<\/a> lists the deadlines by payer and what happens when you miss one.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Want the whole billing cycle in view?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/what-is-revenue-cycle-management\/\">Revenue cycle management<\/a> walks through each stage from eligibility check to final payment.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-frequently-asked-questions\" class=\"wp-block-heading\">Frequently asked questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1786951807766\"><h3 class=\"schema-faq-question\">What is CPT code 11462 used for?<\/h3> <p class=\"schema-faq-answer\">CPT code 11462 reports excision of skin and subcutaneous tissue for inguinal hidradenitis suppurativa, with simple or intermediate repair. It applies when a surgeon removes affected skin and tissue at that site and closes the wound with direct suture layers. Complex closures such as flaps or grafts are reported with 11463 instead.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786951807767\"><h3 class=\"schema-faq-question\">What is the Medicare reimbursement rate for CPT code 11462?<\/h3> <p class=\"schema-faq-answer\">The 2026 Medicare national non-facility rate for CPT code 11462 is about $450, and the facility rate is about $243. Those figures come from 13.46 total RVUs in the non-facility setting and 7.27 in a facility. Reimbursement then varies by locality, so check the CMS Physician Fee Schedule lookup tool before you submit.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786951807769\"><h3 class=\"schema-faq-question\">What ICD-10 codes are used with CPT 11462?<\/h3> <p class=\"schema-faq-answer\">ICD-10-CM L73.2 (hidradenitis suppurativa) is the primary diagnosis code paired with CPT 11462. In addition, secondary codes such as L02.214 (cutaneous abscess of groin) may be added when the operative note documents a concurrent abscess. Even so, never substitute a nonspecific skin condition code for L73.2 when the clinical record clearly identifies hidradenitis suppurativa as the indication for surgery.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786951807771\"><h3 class=\"schema-faq-question\">What is hidradenitis suppurativa and how is it coded?<\/h3> <p class=\"schema-faq-answer\">Hidradenitis suppurativa is a chronic inflammatory skin condition affecting apocrine-gland-rich areas including the axillae, groin, and perianal regions. As a result, it causes recurring abscesses, nodules, and scarring. Clinically, the diagnosis is coded in ICD-10-CM as L73.2, and surgical excision is reported from the 11450-11471 code family. <\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786951807772\"><h3 class=\"schema-faq-question\">Does Medicare cover CPT code 11462?<\/h3> <p class=\"schema-faq-answer\">Yes, Medicare covers CPT code 11462 when the medical record supports surgical necessity for hidradenitis suppurativa and documents prior failure of conservative treatment. However, no single national CMS article sets the coverage criteria for this code family. Instead, your Medicare Administrative Contractor&#8217;s Local Coverage Determination is the document to check before billing.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>What CPT code 11462 covers CPT code 11462 covers excision of skin and subcutaneous tissue for hidradenitis suppurativa in the inguinal region. Specifically, the wound must be closed with simple or intermediate repair. Otherwise, a complex closure at the same site is reported with 11463. Two details in the operative note decide the code: the [&hellip;]<\/p>\n","protected":false},"author":84,"featured_media":180953,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"80","_yoast_wpseo_content_score":"60","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1546],"tags":[1364,4126,1602,1534,1604,1236],"class_list":["post-180955","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-cpt-codes","tag-billing","tag-cpt","tag-cpt-modifiers","tag-dermatology-billing","tag-excision-codes","tag-medicare-reimbursement"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.2 (Yoast SEO v28.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>CPT Code 11462: Inguinal hidradenitis excision billing guide<\/title>\n<meta name=\"description\" content=\"CPT 11462 covers inguinal hidradenitis excision with repair. Medicare pays about $450 non-facility in 2026.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-11462\/\" \/>\n<meta property=\"og:locale\" content=\"nl_NL\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CPT Code 11462: Inguinal hidradenitis excision billing guide\" \/>\n<meta property=\"og:description\" content=\"CPT 11462 covers inguinal hidradenitis excision with repair. Medicare pays about $450 non-facility in 2026.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-11462\/\" \/>\n<meta property=\"og:site_name\" content=\"Pabau\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/Pabau\/\" \/>\n<meta property=\"article:published_time\" content=\"2026-08-18T07:21:59+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-08-18T13:58:17+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/08\/cpt-code-11462.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"630\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Despina Petrushevska\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:site\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:label1\" content=\"Geschreven door\" \/>\n\t<meta name=\"twitter:data1\" content=\"Despina Petrushevska\" \/>\n\t<meta name=\"twitter:label2\" content=\"Geschatte leestijd\" \/>\n\t<meta name=\"twitter:data2\" content=\"12 minuten\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-11462\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-11462\\\/\"},\"author\":{\"name\":\"Despina Petrushevska\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/#\\\/schema\\\/person\\\/80e6d36732fad68140a849f3c351449b\"},\"headline\":\"CPT Code 11462: Inguinal hidradenitis excision billing guide\",\"datePublished\":\"2026-08-18T07:21:59+00:00\",\"dateModified\":\"2026-08-18T13:58:17+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-11462\\\/\"},\"wordCount\":2307,\"publisher\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-11462\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/cpt-code-11462.webp\",\"keywords\":[\"billing\",\"cpt\",\"Cpt Modifiers\",\"dermatology billing\",\"Excision Codes\",\"Medicare reimbursement\"],\"articleSection\":[\"Billing Codes\",\"CPT Codes\"],\"inLanguage\":\"nl-NL\"},{\"@type\":[\"WebPage\",\"FAQPage\"],\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-11462\\\/\",\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-11462\\\/\",\"name\":\"CPT Code 11462: Inguinal hidradenitis excision billing guide\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-11462\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-11462\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/cpt-code-11462.webp\",\"datePublished\":\"2026-08-18T07:21:59+00:00\",\"dateModified\":\"2026-08-18T13:58:17+00:00\",\"description\":\"CPT 11462 covers inguinal hidradenitis excision with repair. 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It combines scheduling, electronic health records, clinical forms, payments, marketing automation, reporting, and patient engagement tools into one secure cloud system to help practices streamline operations and grow their business.\",\"foundingDate\":\"2011-10-20\",\"numberOfEmployees\":{\"@type\":\"QuantitativeValue\",\"minValue\":\"201\",\"maxValue\":\"500\"}},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/#\\\/schema\\\/person\\\/80e6d36732fad68140a849f3c351449b\",\"name\":\"Despina Petrushevska\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"nl-NL\",\"@id\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/06\\\/cropped-colour-96x96.png\",\"url\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/06\\\/cropped-colour-96x96.png\",\"contentUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/06\\\/cropped-colour-96x96.png\",\"caption\":\"Despina Petrushevska\"},\"description\":\"Despina Petrushevska is a content writer covering aesthetics, dermatology, and clinic operations, known for making detailed clinical concepts clear and engaging. Outside of work, she enjoys photography, weekend getaways, and finding inspiration in everyday experiences.\",\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/blog\\\/author\\\/despina-petrushevska\\\/\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-11462\\\/#faq-question-1786951807766\",\"position\":1,\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-11462\\\/#faq-question-1786951807766\",\"name\":\"What is CPT code 11462 used for?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"CPT code 11462 reports excision of skin and subcutaneous tissue for inguinal hidradenitis suppurativa, with simple or intermediate repair. It applies when a surgeon removes affected skin and tissue at that site and closes the wound with direct suture layers. 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Reimbursement then varies by locality, so check the CMS Physician Fee Schedule lookup tool before you submit.\",\"inLanguage\":\"nl-NL\"},\"inLanguage\":\"nl-NL\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-11462\\\/#faq-question-1786951807769\",\"position\":3,\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-11462\\\/#faq-question-1786951807769\",\"name\":\"What ICD-10 codes are used with CPT 11462?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"ICD-10-CM L73.2 (hidradenitis suppurativa) is the primary diagnosis code paired with CPT 11462. In addition, secondary codes such as L02.214 (cutaneous abscess of groin) may be added when the operative note documents a concurrent abscess. 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Outside of work, she enjoys photography, weekend getaways, and finding inspiration in everyday experiences.","url":"https:\/\/pabau.com\/nl\/blog\/author\/despina-petrushevska\/"},{"@type":"Question","@id":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-11462\/#faq-question-1786951807766","position":1,"url":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-11462\/#faq-question-1786951807766","name":"What is CPT code 11462 used for?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT code 11462 reports excision of skin and subcutaneous tissue for inguinal hidradenitis suppurativa, with simple or intermediate repair. It applies when a surgeon removes affected skin and tissue at that site and closes the wound with direct suture layers. Complex closures such as flaps or grafts are reported with 11463 instead.","inLanguage":"nl-NL"},"inLanguage":"nl-NL"},{"@type":"Question","@id":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-11462\/#faq-question-1786951807767","position":2,"url":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-11462\/#faq-question-1786951807767","name":"What is the Medicare reimbursement rate for CPT code 11462?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"The 2026 Medicare national non-facility rate for CPT code 11462 is about $450, and the facility rate is about $243. Those figures come from 13.46 total RVUs in the non-facility setting and 7.27 in a facility. Reimbursement then varies by locality, so check the CMS Physician Fee Schedule lookup tool before you submit.","inLanguage":"nl-NL"},"inLanguage":"nl-NL"},{"@type":"Question","@id":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-11462\/#faq-question-1786951807769","position":3,"url":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-11462\/#faq-question-1786951807769","name":"What ICD-10 codes are used with CPT 11462?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"ICD-10-CM L73.2 (hidradenitis suppurativa) is the primary diagnosis code paired with CPT 11462. In addition, secondary codes such as L02.214 (cutaneous abscess of groin) may be added when the operative note documents a concurrent abscess. Even so, never substitute a nonspecific skin condition code for L73.2 when the clinical record clearly identifies hidradenitis suppurativa as the indication for surgery.","inLanguage":"nl-NL"},"inLanguage":"nl-NL"},{"@type":"Question","@id":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-11462\/#faq-question-1786951807771","position":4,"url":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-11462\/#faq-question-1786951807771","name":"What is hidradenitis suppurativa and how is it coded?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Hidradenitis suppurativa is a chronic inflammatory skin condition affecting apocrine-gland-rich areas including the axillae, groin, and perianal regions. As a result, it causes recurring abscesses, nodules, and scarring. Clinically, the diagnosis is coded in ICD-10-CM as L73.2, and surgical excision is reported from the 11450-11471 code family. ","inLanguage":"nl-NL"},"inLanguage":"nl-NL"},{"@type":"Question","@id":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-11462\/#faq-question-1786951807772","position":5,"url":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-11462\/#faq-question-1786951807772","name":"Does Medicare cover CPT code 11462?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Yes, Medicare covers CPT code 11462 when the medical record supports surgical necessity for hidradenitis suppurativa and documents prior failure of conservative treatment. However, no single national CMS article sets the coverage criteria for this code family. Instead, your Medicare Administrative Contractor's Local Coverage Determination is the document to check before billing.","inLanguage":"nl-NL"},"inLanguage":"nl-NL"}]}},"yoast":{"focus_keyword":"CPT code 11462","seo_title":"CPT Code 11462: Inguinal hidradenitis excision billing guide","meta_description":"CPT 11462 covers inguinal hidradenitis excision with repair. 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