Find policies, billing codes, payers, states, and providers
CPT 10061: Complicated Incision and Drainage of Abscess
CPT code 10061 denotes a complicated incision and drainage (I&D) of an abscess, a common surgical procedure used to evacuate pus from localized infections such as carbuncles, hidradenitis, cysts, furuncles, and paronychia. This code captures procedures that require multiple incisions, drain placement, extensive packing, or more complex wound closure than a simple, single incision. Nationally, accurate use of 10061 matters for clinical documentation, appropriate payment, and quality measurement because it differentiates more resource-intensive treatments from simpler I&Ds coded with 10060.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. The publication provides readers with benchmark context for coding and claim classification, an overview of typical clinical scenarios supporting the code, and comparisons to related procedural codes. It highlights service settings where 10061 is commonly reported—ambulatory surgical centers, hospital outpatient departments, emergency departments, and sometimes office-based procedures—and explains distinctions between complicated and simple I&D services.
Readers will gain a concise reference for when 10061 is applicable, how it relates to adjacent codes, and what clinical features typically justify its use. Data-driven benchmarks, payer policy patterns, and coding nuances that affect billing and reimbursement are summarized to support accurate claims processing and consistent documentation practices.
Customize your policy alerts
Sign up for cpt 10061 policy alerts
Get alerted when payer policies referencing 10061 are released or updated.
Monitor payer policy activity
Billing Code Overview
CPT code 10061 describes a complicated incision and drainage of an abscess. The procedure involves making one or more surgical incisions to open and drain a collection of pus related to conditions such as carbuncles, hidradenitis, cysts, furuncles, or paronychia. A complicated service may include multiple incisions, placement of drains, extensive wound packing, and more complex wound management or closure techniques.
Service type: Surgical incision and drainage; complicated
Typical site of service: Ambulatory surgical center, hospital outpatient department, or emergency department; procedure may also be performed in an office setting when appropriate
National Reimbursement Benchmarks
Medicare’s mean payment of $226.90 sits below BUCA’s average commercial mean of $317.90, indicating commercial contracts on average pay roughly $91 more than Medicare for CPT 10061. This gap highlights a distinct separation between government and commercial reimbursement levels, with BUCA representing a higher commercial baseline compared with Medicare’s $226.90 mean.
Rate dispersion (P75 minus P25) is tightest for Aetna at $150.00 (P75 $250.00 minus P25 $100.90) and widest for Blue Cross Blue Shield at $166.80 (P75 $423.60 minus P25 $269.80). UnitedHealth Group and Cigna have similar dispersion measures of $208.30 (UnitedHealth Group P75 $410.80 minus P25 $202.50) and $193.30 (Cigna P75 $405.20 minus P25 $212.00), while BUCA’s interquartile spread is $167.40 (P75 $394.30 minus P25 $226.90).