HCPCS code T1001: Nursing assessment/evaluation billing guide
T1001 covers an RN nursing assessment for Medicaid. Most denials come from a mis...
Last Updated: August 18, 2026
Key takeaways
CPT code 11462 covers inguinal hidradenitis excision closed with simple or intermediate repair.
A complex closure at the same site is 11463, and that one note detail decides the code.
ICD-10-CM L73.2 is the primary diagnosis code that supports medical necessity for 11462.
The 2026 Medicare national rate is about $450 non-facility and about $243 in a facility.
No national CMS article covers the 11450-11471 family, so read your own MAC’s LCD.
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 first is the anatomical site, and the second is the closure type. In practice, claims management software built for surgical practices flags either one before the claim goes out.
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: Excision of skin and subcutaneous tissue for hidradenitis, inguinal; with simple or intermediate repair. Altogether, three elements define its scope.
- Condition: Hidradenitis suppurativa (HS), a chronic inflammatory skin disease affecting apocrine-gland-rich areas
- Site: Inguinal region (groin) only, which separates it from the axillary codes 11450 and 11451
- Repair complexity: Simple or intermediate closure only. Complex repair at the same site is reported with 11463
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 dermatology EMR should force a repair-type check before the claim is coded.
Medicare reimbursement and fee schedule
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 CMS Physician Fee Schedule.
Those national figures come from the code’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.
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’s own fee schedule.
Pro Tip
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.
Modifiers that apply to 11462
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.
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’s preference in their billing guidelines before you submit. For Medicare specifically, the bilateral adjustment pays 150% of the single rate, not double.
ICD-10 diagnosis codes that support the claim
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 claim denials for this procedure.
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’s Local Coverage Determination.
What the operative note must document
Post-payment audits for skin excision codes turn on what the operative note says. For that reason, electronic client records with structured note templates keep the required elements in front of the surgeon. Specifically, the note for 11462 must contain all of the following.
- Confirmed diagnosis: Explicit statement that the condition treated is hidradenitis suppurativa, ideally referencing prior clinical or pathological confirmation
- Anatomical site specificity: Documentation must state “inguinal” or “groin” region. Otherwise, unspecified site documentation disqualifies the claim for 11462 and creates audit risk
- Description of tissue excised: The operative note must describe the extent of skin and subcutaneous tissue removed, including approximate dimensions
- Repair type documented: 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
- Medical necessity justification: Notes should reflect the conservative treatment history (antibiotics, wound care, drainage) that preceded the decision to operate
- Pathology report: Sending excised tissue to pathology is not always required. It backs up medical necessity, so it is worth doing for audit protection
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 clean claim more often.
Coverage and medical necessity criteria
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.
No national coverage article addresses the 11450-11471 family, so your MAC’s LCD is the document that governs. Criteria differ between contractors, and a requirement one MAC publishes may not appear in another’s policy.
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’s requirement. That said, HIPAA documentation practices still govern how you store and disclose them.
- Covered indication: Active hidradenitis suppurativa with documented failure of conservative management (antibiotics, topical treatments, drainage)
- Non-covered indication: Prophylactic or cosmetically motivated excision without documented HS diagnosis and conservative treatment failure
- Commercial payer variation: Plans may apply different criteria or require prior authorization. Verify before scheduling the procedure
Related CPT codes for hidradenitis excision
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.
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 11450.
Common billing errors and how to avoid them
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 billing compliance routines is what prevents them.
- Wrong repair type coded: 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 “advancement flap” but the claim shows 11462, recoupment follows. Fix: add repair-type confirmation as a required field in your post-op coding checklist.
- Wrong site selection: 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.
- Missing or unsupported modifier 50: 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.
- Unbundling the repair: 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.
Practices running a plastic surgery EMR 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 AAPC CPT code search carries the parenthetical notes and bundling guidance built into the official descriptions.
Pro Tip
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.
How Pabau keeps 11462 documentation audit-ready
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.
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.
Pabau’s claims tools submit and track each claim, so a denial surfaces while the appeal window is still open. In turn, that turns denial management into a short weekly review rather than a monthly scramble. Importantly, every Pabau subscription includes all of it, with no higher tier to unlock.
Reduce claim denials for surgical procedures
Structured note templates capture the site and the repair type at the point of care. Pabau’s claims tools then submit and track the claim, so an 11462 denial surfaces early.
Conclusion
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.
Fix the note, and the modifier questions mostly answer themselves. For example, a surgeon who writes “bilateral inguinal, layered closure” has already chosen the code and justified modifier 50.
Get that habit in place before your next quarterly audit rather than after it. Book a demo to see how Pabau structures operative notes so surgical claims go out defensible.
Continue your research
Coding the axillary version of this procedure? 11450 covers hidradenitis excision at the axilla with simple or intermediate repair.
Need to know what the payer receives? 837 file explains the electronic claim format your clearinghouse sends on your behalf.
Posting payments and denials by hand? Electronic remittance advice shows how to read the 835 and reconcile it against the claim.
Not sure how long you have to file? Timely filing limits lists the deadlines by payer and what happens when you miss one.
Want the whole billing cycle in view? Revenue cycle management walks through each stage from eligibility check to final payment.
Frequently asked questions
What is CPT code 11462 used for?
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.
What is the Medicare reimbursement rate for CPT code 11462?
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.
What ICD-10 codes are used with CPT 11462?
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.
What is hidradenitis suppurativa and how is it coded?
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.
Does Medicare cover CPT code 11462?
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.
