CPT code 17274: Destruction of malignant lesion, 3.1-4.0 cm

Key takeaways

CPT code 17274 describes destruction of a malignant skin lesion on the scalp, neck, hands, feet, or genitalia measuring 3.1 to 4.0 cm in diameter.

Code selection depends on two axes: anatomic location (scalp/neck/hands/feet/genitalia) and measured lesion diameter. A lesion 0.1 cm outside the 3.1-4.0 cm range maps to a different code.

Missing lesion size measurement or anatomic location in the operative note is the leading cause of CPT 17274 claim denials. Document both at the time of service.

Pabau’s claims management software and digital clinical forms help dermatology and skin clinic teams capture the documentation elements required to bill CPT 17274 accurately.

Billing errors on malignant lesion destruction claims rarely come from selecting the wrong procedure category. They come from selecting the wrong code within the right category. For dermatology practices and skin clinics, that distinction costs revenue.

CPT Code 17274 is the American Medical Association-maintained code for destruction of a malignant skin lesion on the scalp, neck, hands, feet, or genitalia. The lesion diameter must measure 3.1 to 4.0 cm. The full official descriptor reads: Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm.

Two facts determine whether this code applies: the anatomic site and the measured lesion diameter. Both must match exactly. A 3.0 cm lesion on the scalp is 17273, not 17274. A 3.5 cm lesion on the trunk is a different code series entirely (17260-17266). Getting either wrong generates a denial or an audit flag.

CPT code 17274 and the 17270-17276 series: Code selection criteria

CPT Code 17274 belongs to the 17270-17276 malignant lesion destruction series, which covers scalp, neck, hands, feet, and genitalia. A parallel series (17260-17266) covers trunk, arms, and legs. Selecting correctly means matching both the anatomic group and the size tier. A third series (17280-17286) covers the face, ears, eyelids, nose, lips, and mucous membranes. Reconstruction there often pairs with a code such as 15823 for an eyelid repair or 13151 for the nose, ears, and lips.

Measure at the widest point of the lesion at the time of service, before any debridement or margin preparation. Document the measurement in the operative or procedure note. Relying on a pre-procedure biopsy measurement without confirming intraoperatively is a common documentation error that payers flag.

Destruction methods covered

CPT Code 17274 is method-neutral. Any of the following techniques qualifies, provided the method is documented:

• Laser surgery – ablative laser destruction of the lesion tissue
• Electrosurgery – high-frequency electrical current to destroy tissue
• Cryosurgery – liquid nitrogen or other cryogen to freeze and destroy the lesion
• Chemosurgery – staged excision using chemical fixatives (Mohs-adjacent, though Mohs has its own code series)
• Surgical curettement – mechanical scraping to remove malignant tissue

The method does not change the code or the reimbursement rate. Record which technique was used in the procedure note; payers may request this during audit review.

CPT code 17274 reimbursement and fee schedule

Medicare reimbursement for CPT Code 17274 is calculated using Relative Value Units (RVUs) applied against the annual Medicare Physician Fee Schedule. Rates change each January. Use the CMS Physician Fee Schedule lookup or the FastRVU 2026 RVU tool to confirm current allowable amounts for your geographic area before submitting claims.

Facility and non-facility rates differ. Non-facility (office-based) reimbursement is typically higher because it includes practice expense RVUs. Facility rates apply when the procedure is performed in a hospital outpatient department or ambulatory surgical center. Always select the correct place-of-service code (11 for office, 22 for outpatient hospital) to ensure the right rate applies.

Medicare coverage requirements

Medicare covers destruction of malignant skin lesions under CMS coverage policy when medical necessity is established. Three elements must be present in the medical record to support a claim:

• A histopathologic diagnosis confirming malignancy (biopsy report or pathology note)
• Documented lesion size at the anatomic location coded
• Clinical rationale supporting destruction as the appropriate treatment approach

Local Coverage Determinations (LCDs) from Medicare Administrative Contractors (MACs) govern specific coverage criteria in each region. Check your regional MAC’s LCD for skin lesion destruction before billing; coverage requirements can differ by contractor. Medical necessity is always case-specific and payer-specific; general coding guidance does not guarantee coverage for any individual claim.

Modifiers for CPT code 17274

Modifier selection for CPT Code 17274 depends on what else is being billed on the same date of service. Using the right modifier prevents bundling edits and supports clean claim adjudication. Using the wrong one, or omitting a required modifier, triggers an automatic denial.

Modifier 59 warrants special attention. The National Correct Coding Initiative (NCCI) bundles many procedure code pairs. When 17274 appears on the same claim as a bundled code, modifier 59 signals a distinct service. A common bundled pair is 17274 with an intermediate repair such as 12055, when wound closure goes beyond simple sutures. The Office of Inspector General (OIG) audits modifier 59 usage specifically because it is frequently misapplied. Documentation must clearly support a separate anatomic site, a separate session, or a genuinely distinct procedural circumstance.

ICD-10 codes that support medical necessity for CPT code 17274

A claim for CPT Code 17274 requires a supporting ICD-10-CM diagnosis that establishes malignancy at the coded anatomic location. The C44 series (other malignant neoplasms of skin) provides the primary codes. A lesion on the face, ears, or lips instead falls under the separate 17286 series.

Payers may deny claims where the ICD-10 code maps to a body region not covered by the 17270-17276 series. A squamous cell carcinoma on the back (C44.52x) does not support CPT 17274; the trunk series (17260-17266) applies there. Always verify the anatomic match between the ICD-10 code and the CPT code before submitting.

Documentation requirements for CPT code 17274

CMS requires specific documentation elements to support medical necessity for malignant lesion destruction. Missing any one of them can result in a denial or a post-payment audit recoupment. Practices using digital clinical forms can build these elements into structured procedure templates so nothing is omitted at the point of care. For a broader look at structured medical documentation across healthcare settings, the principles are consistent regardless of specialty.

• Histopathologic diagnosis – pathology or biopsy report confirming malignancy; the diagnosis code must match the documented histology
• Lesion size measurement – exact diameter in centimeters or millimeters, measured at the widest point at the time of the procedure
• Anatomic location – specific site within the covered group (e.g., dorsum of the right hand, posterior scalp). “Scalp” alone is acceptable, but “skin lesion” without a location is not.
• Destruction method – document which technique was used (laser, electrosurgery, cryosurgery, chemosurgery, or curettement)
• Medical necessity statement – clinical rationale for why destruction was chosen over excision or other approaches
• Provider credentials – performing provider’s NPI and applicable specialty designation

For practices managing patient documentation compliance across multiple providers, a standardized procedure note template reduces variability. The note should be completed the same day as the procedure, before sign-off.

Common denial reasons and how to avoid them

CPT Code 17274 denials cluster around a short list of repeatable errors. Fixing the workflow upstream prevents most of them. For practices working through medical spa compliance requirements or HIPAA-compliant billing workflows, the same documentation discipline applies here.

Practices with high denial rates on this code typically share one pattern: they code from the biopsy report rather than from an intraoperative measurement. The biopsy site measurement and the destruction site measurement are not always the same.

Billing multiple lesion destructions in the same session

Destroying more than one malignant lesion on the same date is common in dermatology. Each lesion is billed on a separate line item using the code that matches its individual size and location. A 3.5 cm scalp lesion and a 1.2 cm neck lesion on the same visit generate two separate codes: 17274 and 17271. Bill them on separate lines, with modifier 51 on the secondary code.

NCCI edits may affect how multiple destruction codes are processed together. Check the NCCI edit table for the specific code pair before submitting. When two codes are in the same code family and the NCCI edit applies, modifier 59 may be required on the secondary code. Documentation must support a distinct anatomic site. For full-body mole mapping workflows, structured documentation from the initial assessment forward reduces ambiguity at billing time.

Each lesion on a multi-lesion claim needs its own documented measurement and anatomic location in the procedure note. A single note that says “multiple lesions destroyed” without differentiating each one by size and site will not withstand audit review.

How Pabau supports accurate CPT code 17274 documentation and billing

Dermatology and skin clinic teams typically lose revenue on malignant lesion destruction codes for one core reason. What happened in the room does not always match what got recorded in the note. When a provider relies on memory to reconstruct lesion measurements after the fact, size errors happen.

Pabau’s claims management software connects clinical documentation directly to the billing workflow. Structured procedure note templates can be configured to require lesion size, anatomic location, and destruction method before the note is finalized. That means the billing team always has the data elements required for CPT Code 17274. The clinical team builds documentation discipline into the natural workflow, rather than treating it as a separate task. That consistency reduces audit risk for practices managing multiple providers or locations.

Reduce CPT 17274 denials with structured documentation

Pabau's claims management software connects clinical note-taking directly to billing, helping skin clinics and dermatology practices capture lesion size, anatomic location, and destruction method at the point of care. Fewer missing data points means fewer denials.

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Practices billing excision rather than destruction for a similar lesion should reference 11603 for trunk, arm, or leg sites instead.

Conclusion

CPT Code 17274 leaves no room for guesswork. Measure the lesion at the time of the procedure, and confirm the site sits within the 17270-17276 series before the claim goes out. Skip either check, and the claim comes back regardless of how well the procedure itself was performed.

Pabau’s structured clinical notes and integrated billing workflow give skin clinics the tools to capture every required data element at the point of care. That means coding accuracy stops depending on individual memory. Book a demo to see how it works for your practice.

Continue your research

Need a compliance framework for your skin clinic? Skin clinic software covers how Pabau supports documentation, billing, and patient management in dermatology and aesthetic skin practices.

Managing claims across multiple providers or locations? Medical spa compliance requirements outlines the documentation and workflow standards that apply to multi-provider aesthetic practices.

Want to reduce administrative errors in your procedure notes? Structured medical documentation explains how standardized forms reduce variability and support cleaner claims across clinical settings.

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