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In-Facility Not In-Facility - Maryland Flipbook PDF
Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), all benign or premal
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Reimbursement Rate* Skin Cancers
@
CPT Code Procedure
Region 99 In-Facility
Not In-Facility
Medicare Region 1 In-Facility
DC Metro
Not In-Facility
In-Facility
Not In-Facility
Medicaid^ All Maryland
Excision, benign lesion, trunk, arms or legs lesion diam: 0.5 cm or < lesion diam: 0.6 cm - 1.0cm lesion diam: 1.1 cm - 2.0cm lesion diam: 2.1 cm - 3.0cm lesion diam: 3.1 cm - 4.0cm lesion diam: over 4.0 cm
11400 11401 11402 11403 11404 11406
$76.77 $101.18 $111.67 $142.31 $157.52 $237.03
$117.72 $143.86 $160.20 $183.95 $209.15 $297.61
$81.14 $106.99 $118.12 $150.55 $166.66 $250.74
$124.97 $152.66 $170.05 $195.12 $221.90 $315.56
$87.36 $114.58 $126.24 $160.91 $177.69 $265.40
$136.60 $165.90 $184.60 $210.98 $239.77 $338.24
$85.56 $102.21 $113.52 $130.15 $147.88 $195.91
NF NF NF NF NF NF
Excision, benign lesion, scalp, neck, hands, feet, genitalia lesion diam: 0.5 cm or < lesion diam: 0.6 cm - 1.0cm lesion diam: 1.1 cm - 2.0cm lesion diam: 2.1 cm - 3.0cm lesion diam: 3.1 cm - 4.0cm lesion diam: over 4.0 cm
11420 11421 11422 11423 11424 11426
$80.16 $109.31 $132.53 $154.21 $176.20 $268.37
$117.33 $152.33 $169.70 $196.55 $225.76 $322.41
$84.53 $115.45 $140.12 $163.00 $186.18 $283.45
$124.31 $161.49 $179.89 $208.30 $239.22 $341.27
$90.74 $123.33 $150.07 $174.03 $198.13 $300.00
$135.44 $175.05 $194.76 $224.93 $257.72 $364.97
$85.33 $108.78 $121.61 $141.69 $162.34 $229.98
NF NF NF NF NF NF
Excision, benign lesion, face, ears, eyelids nose, lips lesion diam: 0.5 cm or < lesion diam: 0.6 cm - 1.0cm lesion diam: 1.1 cm - 2.0cm lesion diam: 2.1 cm - 3.0cm lesion diam: 3.1 cm - 4.0cm lesion diam: over 4.0 cm
11440 11441 11442 11443 11444 11446
$99.66 $128.85 $143.42 $176.00 $224.16 $319.48
$129.60 $162.93 $183.69 $218.67 $274.75 $377.99
$105.57 $136.35 $151.77 $186.06 $236.78 $337.32
$137.61 $172.82 $194.86 $231.73 $290.92 $399.93
$114.03 $146.47 $162.65 $198.67 $251.87 $357.55
$150.03 $187.44 $211.07 $249.98 $312.70 $427.91
$95.04 $117.18 $131.53 $157.89 $198.25 $264.75
NF NF NF NF NF NF
Excision, malignant lesion, trunk, arms or legs lesion diam: 0.5 cm or < lesion diam: 0.6 cm - 1.0cm lesion diam: 1.1 cm - 2.0cm lesion diam: 2.1 cm - 3.0cm
11600 11601 11602 11603
$116.02 $147.73 $162.71 $193.26
$183.14 $222.76 $243.59 $276.55
$122.55 $155.94 $171.76 $203.87
$194.37 $236.23 $258.32 $293.00
$130.49 $166.20 $183.12 $216.81
$211.19 $256.42 $280.37 $316.96
$123.84 $146.76 $159.76 $181.5
NF NF NF NF
CCSC#11-14-Att2011CPTRevised03012011
Skin Cancer 2011 Medicare and Medicaid Rates1
Reimbursement Rate* @
CPT Code Skin Cancers (continued) Procedure
lesion diam: lesion diam:
3.1 cm - 4.0cm over 4.0 cm
Medicare Region 1
Region 99 In-Facility
Not In-Facility
In-Facility
Medicaid^ All Maryland
DC Metro
Not In-Facility
In-Facility
Not In-Facility
11604 11606
$212.46 $313.67
$306.42 $433.44
$224.30 $331.11
$324.85 $459.28
$237.91 $349.29
$350.89 $237.91
$200.54 NF $279.34 NF
Excision, malignant lesion, scalp, neck, hands, feet, genitalia lesion diam: 0.5 cm or < lesion diam: 0.6 cm - 1.0cm lesion diam: 1.1 cm - 2.0cm lesion diam: 2.1 cm - 3.0cm lesion diam: 3.1 cm - 4.0cm lesion diam: over 4.0 cm
11620 11621 11622 11623 11624 11626
$118.08 $149.10 $171.87 $211.19 $238.91 $294.43
$186.58 $224.48 $252.75 $295.17 $331.50 $400.09
$124.74 $157.39 $181.46 $222.90 $252.21 $310.85
$198.03 $238.05 $268.01 $312.76 $351.28 $423.92
$132.92 $167.80 $193.34 $236.75 $267.22 $328.44
$215.27 $258.43 $290.59 $337.72 $378.54 $455.49
$124.51 $147.95 $66.74 $194.9 $220.59 $282.45
NF NF NF NF NF NF
Excision, malignant lesion, face, ears, eyelids, nose, lips lesion diam: 0.5 cm or < lesion diam: 0.6 cm - 1.0cm lesion diam: 1.1 cm - 2.0cm lesion diam: 2.1 cm - 3.0cm lesion diam: 3.1 cm - 4.0cm lesion diam: over 4.0 cm
11640 11641 11642 11643 11644 11646
$123.24 $157.27 $185.16 $231.24 $286.52 $399.11
$193.79 $234.37 $268.45 $315.91 $389.09 $508.91
$130.19 $166.07 $195.41 $244.05 $302.42 $421.18
$205.70 $248.57 $284.54 $334.65 $412.17 $538.67
$138.95 $177.12 $208.18 $259.14 $320.49 $445.21
$223.79 $269.82 $308.32 $360.94 $443.81 $577.22
$130.15 $162.39 $187.65 $216.86 $274.14 $363.68
NF NF NF NF NF NF
Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), all benign or premalignant lesions (e.g., actinic keratoses) other than skin tags or cutaneous vascular proliferative lesions; first lesion 17000
$55.63
$80.07
$58.77
$84.92
$63.33
$92.71
CCSC#11-14-Att2011CPTRevised03012011
$52.42 NF
Skin Cancer 2011 Medicare and Medicaid Rates2
Reimbursement Rate* Skin Cancer (continued) Procedure
Code
In-Facility
Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), all benign or premalignant lesions (e.g., actinic keratoses) other than skin tags or cutaneous vascular proliferative lesions; second through 14 lesions, each (List separately in addition to code for first lesion)
17003 Add-on code (use 17003 in conjunction with code 17000)
17004 (Do not report Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, 17004 in conjuncsurgical curettement), all benign or tion with premalignant lesions (e.g., actinic codes keratoses) other than skin tags or cutaneous vascular proliferative lesions; 15 17000or more lesions, 17003)
Medicare @ Region 1
Region 99 Not-In-Facility
In-Facility
Medicaid^ All Maryland
DC Metro
Not-In-Facility In-Facility
Not-In-Facility
$4.42
$7.17
$4.65
$7.60
$4.93
$8.24
$5.54 NF
$134.50
$172.70
$141.97
$182.85
$151.52
$197.46
$125.21 NF
Destruction, malignant lesion (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk,arms or legs; lesion diameter 0.5 cm or less
17260
$68.14
$94.30
$71.80
$99.79
$76.66
$108.11
$67.62 NF
Destruction, malignant lesion (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk,arms or legs; lesion diameter 0.6 to 1.0 cm
17261
$92.65
$142.56
$97.87
$151.27
$104.68
$164.68
$93.19 NF
CCSC#11-14-Att2011CPTRevised03012011
Skin Cancer 2011 Medicare and Medicaid Rates3
Reimbursement Rate* Skin Cancer (continued) Procedure
Code
Region 99 In-Facility
Not-In-Facility
Medicare @ Region 1 In-Facility
Medicaid^ All Maryland
DC Metro
Not-In-Facility In-Facility
Not-In-Facility
Destruction, malignant lesion (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk,arms or legs; lesion diameter 1.1 to 2.0 cm
17262
$117.83
$172.90
$124.33
$183.25
$132.70
$198.91
$113.09 NF
Destruction, malignant lesion (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk,arms or legs; lesion diameter 2.1 to 3.0 cm
17263
$130.40
$190.29
$137.55
$201.64
$146.66
$218.67
$124.54 NF
Destruction, malignant lesion (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk,arms or legs; lesion diameter 3.1 to 4.0 cm
17264
$139.21
$203.91
$146.86
$216.10
$156.41
$234.21
$134.54 NF
Destruction, malignant lesion (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk,arms or legs; lesion diameter over 4.0 cm 17266
$161.98
$231.16
$170.76
$244.79
$181.60
$264.78
$152.36 NF
Destruction, malignant lesion (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less 17270
$100.46
$148.64
$106.05
$157.61
$113.24
$171.17
$97.50 NF
CCSC#11-14-Att2011CPTRevised03012011
Skin Cancer 2011 Medicare and Medicaid Rates4
Skin Cancer (continued) Procedure
Code
Reimbursement Rates Medicare @ Region 99 Region 1 In-Facility
Not-In-Facility
In-Facility
Medicaid^ All Maryland
DC Metro
Not-In-Facility In-Facility
Not-In-Facility
Destruction, malignant lesion (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm 17271
$112.70
$163.29
$119.00
$173.14
$127.01
$187.85
$106.59 NF
Destruction, malignant lesion (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm 17272
$129.72
$186.17
$136.86
$197.26
$145.95
$213.82
$122.14 NF
Destruction, malignant lesion (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm 17273
$146.37
$207.29
$154.38
$219.57
$164.42
$237.67
$135.91 NF
Destruction, malignant lesion (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm 17274
$178.66
$244.40
$188.32
$258.67
$200.29
$279.33
$161.63 NF
Destruction, malignant lesion (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm 17276
$213.92
$282.76
$225.51
$299.17
$239.29
$322.06
$190.17 NF
CCSC#11-14-Att2011CPTRevised03012011
Skin Cancer 2011 Medicare and Medicaid Rates5
Skin Cancer (continued) Procedure
Code
Reimbursement Rate* Medicare @ Region 99 Region 1 In-Facility
Not-In-Facility
In-Facility
Medicaid^ All Maryland
DC Metro
Not-In-Facility In-Facility
Not-In-Facility
Destruction, malignant lesion (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less 17280
$91.62
Destruction, malignant lesion (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm 17281
$126.64
$176.55
$133.66
$187.06
$142.51
$202.52
$115.58 NF
Destruction, malignant lesion (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm 17282
$146.37
$204.54
$154.40
$216.64
$164.48
$234.42
$133.82 NF
Destruction, malignant lesion (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm 17283
$182.40
$245.73
$192.28
$260.05
$204.51
$280.65
$161.86 NF
Destruction, malignant lesion (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm 17284
$216.07
$284.90
$227.64
$301.30
$241.86
$324.63
$189.09 NF
Destruction, malignant lesion (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm 17286
$289.33
$360.24
$304.97
$380.84
$323.18
$408.43
$250.77 NF
CCSC#11-14-Att2011CPTRevised03012011
$139.46
$96.76
$147.96
$103.44
$160.96
$91.38 NF
Skin Cancer 2011 Medicare and Medicaid Rates6
Skin Cancer (continued) Procedure
Code
Region 99 In-Facility
Not-In-Facility
Reimbursement Rate* Medicare @ Region 1 DC Metro In-Facility
Not-In-Facility In-Facility
Medicaid^ All Maryland
Not-In-Facility
Mohs Micrographic Surgery Chemosurgery (Mohs micrographic technique), including removalof all gross tumors, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and complete histopathologic preparation; first stage, fresh tissue technique, head, neck, hands, feet, genitalia,and other areas (please check with CCSC if nec.) up to 5 specimens 17311
$387.25
$671.89
Chemosurgery (Mohs micrographic technique), as above; each additional stage, fixed or fresh tissue, up to 5 specimens 17312
$205.73
$401.22
Chemosurgery (Mohs micrographic technique), including removalof all gross tumors, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and complete histopathologic preparation; trunk, arms or legs, fixed or fresh tissue, up to 5 specimens
$347.48
$205.73
CCSC#11-14-Att2011CPTRevised03012011
17313
$407.67
$216.50
$365.80
$712.26
$431.49
$425.70
$649.76
$229.21
$387.19
$773.73
$464.27
$706.26
$500.60 NF
$302.82 NF
$457.38 NF
Skin Cancer 2011 Medicare and Medicaid Rates7
Skin Cancer (continued) Procedure
Code
Region 99 In-Facility
Chemosurgery (Mohs micrographic technique), as above in 14313; up to 5 specimens, each stage
Reimbursement Rate* Medicare @ Region 1 DC Metro
Not-In-Facility
17314
$190.76
$372.14
Chemosurgery (Mohs micrographic technique); each block after the first 5 tissue blocks, any stage (listed separately in addition to code for primary procedure) 17315
$54.09
$80.59
CCSC#11-14-Att2011CPTRevised03012011
In-Facility
$200.76
$56.87
Not-In-Facility In-Facility
$394.86
$212.53
$85.23
$60.26
Medicaid^ All Maryland
Not-In-Facility
$430.62
$92.13
$280.46 NF
$58.82 NF
Skin Cancer 2011 Medicare and Medicaid Rates8