Destruction of Precancerous Skin Lesion (First Lesion)
CPT 17000 covers destruction (typically cryotherapy with liquid nitrogen) of the first precancerous skin lesion, usually actinic keratosis from sun damage. Providers charge an average of $151.51, but Medicare pays only $66.47 in an office setting (2.3x markup). The critical billing trap: being charged 17000 for each lesion instead of 17000 for the first and 17003 for each additional. This mistake can multiply your bill by 5 to 10 times.
CPT 17000 at a Glance
- Average provider charge: $151.51
- Medicare rate (office): $66.47
- Medicare rate (hospital physician): $47.76 + facility fee
- Typical markup: 2.3x over Medicare office rate
- Additional lesions (17003): $6.33 Medicare each
- Cash-pay range: $100 to $250 (few lesions)
- Global period: 10 days
- Beneficiaries (2023): 4.1 million
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How the Medicare Rate Is Calculated
Medicare values every procedure using Relative Value Units (RVUs) across three components, then multiplies by a national conversion factor of $33.4009 (2026). For CPT 17000, the Practice Expense RVU differs between office and hospital settings because the office bears the cost of the liquid nitrogen and supplies.
| Component | What It Covers | Office (Non-Facility) | Hospital (Facility) |
|---|---|---|---|
| Work RVU | Physician time and skill | 0.59 | 0.59 |
| Practice Expense RVU | Liquid nitrogen, supplies, staff | 1.34 | 0.78 |
| Malpractice RVU | Professional liability insurance | 0.06 | 0.06 |
| Total RVU | 1.99 | 1.43 | |
| x $33.4009 | 2026 conversion factor | $66.47 | $47.76 |
How Multiple Lesions Should Be Billed
This is the most important thing to understand about skin lesion billing. The first lesion uses CPT 17000. Each additional lesion (2nd through 14th) uses CPT 17003, which pays much less. If 15 or more lesions are treated, CPT 17004 is used as a flat rate. Here is what correct billing looks like:
| Lesions Treated | Correct Billing | Medicare Total | If Incorrectly Billed as All 17000 |
|---|---|---|---|
| 1 lesion | 1x 17000 | $66.47 | $66.47 |
| 3 lesions | 1x 17000 + 2x 17003 | $79.13 | $199.41 |
| 5 lesions | 1x 17000 + 4x 17003 | $91.79 | $332.35 |
| 10 lesions | 1x 17000 + 9x 17003 | $123.44 | $664.70 |
| 15+ lesions | 1x 17004 (flat rate) | Flat rate | $997.05+ |
Medicare Rate by State
Medicare adjusts the national rate based on your location using Geographic Practice Cost Indices (GPCIs). The office rate for the first lesion ranges from about $59 in Arkansas to $78 in Alaska.
Medicare Rate by State (2026)
Medicare adjusts payments by location using Geographic Practice Cost Indices (GPCIs). Select your state to see the adjusted rate.
Sample State Rates (First Lesion)
| State | Medicare (Office) | Medicare (Hospital Physician) | Avg. Charge | Markup |
|---|---|---|---|---|
| Texas (Austin) | $68.87 | $49.08 | $151.51 | 2.2x |
| California (Los Angeles) | $74.79 | $52.66 | $151.51 | 2.0x |
| New York (Manhattan) | $76.15 | $54.42 | $151.51 | 2.0x |
| Florida (Fort Lauderdale) | $68.67 | $49.72 | $151.51 | 2.2x |
| Ohio | $62.59 | $45.51 | $151.51 | 2.4x |
| Mississippi | $59.72 | $43.62 | $151.51 | 2.5x |
| Arkansas | $59.18 | $43.12 | $151.51 | 2.6x |
| Alaska | $78.33 | $58.41 | $151.51 | 1.9x |
Rates shown are for the first lesion only, using 2026 GPCIs and the $33.4009 conversion factor. Markup is calculated against the office rate. The average provider charge of $151.51 is the 2023 national average from CMS utilization data.
What Insured Patients Actually Pay
Your cost depends on your plan design and how many lesions are treated. The numbers below are for the first lesion (17000) only. Additional lesions add $6 to $22 each at negotiated rates.
| Your Situation | What You Likely Pay (first lesion) | How It Works |
|---|---|---|
| Copay plan (deductible met) | $25 to $75 | Specialist or procedure copay |
| Coinsurance plan (deductible met) | $16 to $30 | 20% of negotiated rate ($80 to $150) |
| High-deductible plan (deductible NOT met) | $80 to $150 | Full negotiated rate until deductible is met |
| Medicare Part B | $13.29 | 20% of the Medicare-approved amount ($66.47) |
Common Billing Problems with Skin Lesion Destruction
Billing 17000 for every lesion instead of 17000 + 17003
This is the most significant billing error for this procedure. CPT 17000 is only for the first lesion. Each additional lesion (2nd through 14th) should be billed under 17003 at $6.33 each (Medicare rate) or about $21.96 at average charges. If your bill shows multiple 17000 charges for one visit, contact the billing department immediately. Example: 5 lesions billed correctly is $91.79 at Medicare rates. Five lesions billed as 5x 17000 is $332.35, a 3.6x overbilling.
Follow-up visit billed within the 10-day global period
CPT 17000 has a 10-day global period, meaning routine post-procedure follow-up is included. If your dermatologist asks you to come back in a week to check on the treated areas and bills a separate office visit (99213 or 99214), this may be incorrect. The follow-up should be included in the original procedure payment unless a new, unrelated problem is addressed at the follow-up visit.
Confusion between 17000 (precancerous) and 17110 (benign)
CPT 17000 is for precancerous lesions (actinic keratoses). CPT 17110 is for benign lesions like common warts. They are different codes with different rates and billing rules. If your lesions were benign (warts, skin tags), the bill should show 17110, not 17000. The distinction also matters for insurance coverage, as some plans cover precancerous lesion treatment differently than benign lesion treatment.
Hospital facility fee on a minor dermatology procedure
If your dermatologist practices in a hospital-owned clinic, the hospital physician fee drops from $66.47 to $47.76, but the hospital adds a facility fee of $50 to $200 on top. For a quick liquid nitrogen treatment that takes seconds per lesion, this facility fee can be a significant percentage of the total bill. Independent dermatology offices do not charge facility fees.
Related Skin Lesion Codes
| Code | Description | Medicare Rate (Office) |
|---|---|---|
| 17000 | Destruction, first precancerous lesion | $66.47 |
| 17003 | Each additional precancerous lesion (2nd-14th) | $6.33 |
| 17004 | Destruction, 15+ precancerous lesions (flat rate) | Flat rate |
| 17110 | Destruction of benign lesions (warts, up to 14) | Different rate |
Frequently Asked Questions
How much does it cost to remove precancerous skin lesions?
Destruction of precancerous skin lesions (actinic keratoses) costs $100 to $250 at dermatology offices for cash-pay patients. Medicare pays $66.47 for the first lesion (CPT 17000) and $6.33 for each additional lesion (CPT 17003). The national average provider charge for the first lesion is $151.51. Hospital outpatient departments charge more due to facility fees.
What is the billing difference between 17000 and 17003?
CPT 17000 covers the first precancerous lesion destroyed. CPT 17003 covers each additional lesion from the 2nd through the 14th, at a much lower rate ($6.33 Medicare vs $66.47 for the first). If you have 5 lesions treated, the correct billing is 1x 17000 plus 4x 17003, totaling about $91.79 at Medicare rates. If billed as 5x 17000, that would be $332.35, roughly 3.6 times more.
What does the 10-day global period mean for CPT 17000?
CPT 17000 has a 10-day global period, meaning routine follow-up care within 10 days of the procedure is included in the original payment. Your provider should not bill a separate office visit for checking on the treated areas during this window. If you see a follow-up visit charge within 10 days, ask whether it falls under the global period.
What is the difference between CPT 17000 and 17110?
CPT 17000 is for destruction of precancerous lesions (actinic keratoses). CPT 17110 is for destruction of benign lesions like common warts or molluscum. They are different codes with different rates and indications. Make sure your bill uses the correct code for the type of lesion that was treated. The distinction can also affect insurance coverage.
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