Summary & Overview

CPT 17004: Destruction of 15 or More Premalignant Lesions

Headline: CPT code 17004: Destruction of 15+ Premalignant Lesions, Common Dermatologic Procedure

Lead: CPT code 17004 covers the destruction of 15 or more premalignant lesions using techniques such as chemosurgery, cryosurgery, electrosurgery, or similar methods. This procedural dermatology code is commonly used in outpatient clinic settings and is relevant to clinicians and billing teams across the country managing actinic keratoses and other premalignant skin conditions.

What the code represents and why it matters: CPT code 17004 designates a high-volume lesion destruction encounter — specifically the treatment of 15 or more premalignant lesions. Nationally, this code matters because it documents the scope of procedural dermatologic care delivered in a single session and impacts billing, coding workflows, and aggregated utilization metrics for skin care services.

Key payers covered: The analysis covers major commercial and public payers, including Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare.

What readers will learn: The publication provides clinical context for the procedure, explains typical sites of service, and situates CPT code 17004 within related code anatomy (first lesion and add-on lesion codes). Readers will find benchmarks, policy-relevant observations, and billing considerations relevant to high-volume premalignant lesion destruction encounters.

AetnaBlue Cross Blue ShieldCigna HealthUnited HealthcareMedicareCPT 17004dermatologylesion destructionactinic keratosisprocedural dermatologyoutpatient procedureskin surgerymedical coding

Billing Code Overview

CPT code 17004 describes the destruction of 15 or more premalignant lesions using techniques such as chemosurgery, cryosurgery, electrosurgery, or other destructive methods. The service type is procedural dermatologic lesion destruction. The typical site of service is an ambulatory clinic or outpatient dermatology setting, where procedural lesion destruction is performed under local anesthesia or topical measures.

Clinical & Coding Specifications

Clinical Context

A 72-year-old patient with chronic sun exposure presents to a dermatology clinic with multiple rough, scaly patches on the forehead, scalp, and dorsal hands. The clinician documents more than 15 discrete premalignant lesions consistent with actinic keratoses (L57.0) on examination. After discussion of options, the dermatologist arranges an in‑office procedure using cryosurgery and electrosurgery to destroy the lesions in a single session. The clinical workflow includes: a focused history and targeted skin exam; photographic documentation of lesion distribution; local anesthesia if needed; sequential destruction of lesions with cryotherapy and focal electrodessication; brief post‑procedure wound care instructions and topical dressing as appropriate; documentation of lesion count, technique(s) used, anatomic sites treated, and estimated total time. The encounter note references the diagnosis L57.0 and reports the use of 17004 for destruction of 15 or more premalignant lesions. Follow‑up is arranged for wound check or return if signs of infection or delayed healing develop.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable E/M service by the same physician on the same day

Taxonomy Code	Specialty	Notes
`207N00000X`	Dermatology Physician	General dermatologists commonly perform lesion destruction for actinic keratoses.
`207ND0101X`	MOHS-Micrographic Surgery Physician	MOHS surgeons may perform extensive field treatments or lesion destructions in complex cases.
`207NS0135X`	Procedural Dermatology Physician	Procedural dermatologists perform office‑based destructive techniques including cryosurgery and electrosurgery.

CPT Code	Description	Relationship to This Procedure
`17000`	Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), all benign or premalignant lesions; first lesion	Reported when a single premalignant lesion is destroyed; `17000` is used for the first lesion when fewer than two lesions are treated or to represent the primary lesion when fewer than 15 lesions exist.
`17003`	Add-on code for destruction of premalignant lesion, second through 14th lesion	Used in conjunction with `17000` to report the 2nd–14th lesions; when total lesions reach 15 or more, `17004` is used instead of `17000` + add-on codes.
`17004`	Destruction, 15 or more premalignant lesions (eg, actinic keratoses)	Primary code for the described procedure; used when 15 or more premalignant lesions are destroyed in a single session.

OpenPayer