Does 17264 require prior authorization?

No, 17264 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 17264?

Medicare facility rate: $109.22. Non-facility rate: $202.08. Work RVU: 1.94.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

1.94

Facility

$109.22

Non-Facility

$202.08

Legible medical records must reference the patient's complaint or the physician's physical findings when billing with diagnosis L82.0.
Documentation must support a significant, separately identifiable E/M service when modifier 25 is appended (separate E/M note tied to the visit and not just the procedure).
Verify applicable procedure and global policy coding via the Medicare Physician Fee Schedule Database (MPFSDB) to determine where the global surgical policy applies.
Maintain the complete medical record and make it available to the contractor upon request; every page must be legible and contain appropriate patient identification (e.g., full name, dates of service).

Removal of benign or malignant skin lesions is addressed per the Local Coverage Determination L33445 and related billing/coding guidance.
Diagnosis code L82.0 (inflamed seborrheic keratosis) may be used when the medical record documents the patient's complaint or the physician's physical findings for the lesion.
Destruction of a skin lesion is covered only when the medical record documents the lesion as malignant by a corresponding pathology report or a clinical description consistent with skin malignancy.
The medical record must include lesion size and lesion location to support medical necessity for destruction of a malignant skin lesion.
Services are covered only when they meet all applicable indications and limitations in LCD L33813, CMS payment policy manuals, any relevant national coverage determinations, and Medicare payment rules.
Removal of any malignant skin lesion is considered medically necessary and covered.

A56346 — Billing and Coding: Removal of Benign and Malignant Skin Lesions

A57638 — Billing and Coding: Destruction of Malignant Skin Lesions

L33445 — Removal of Benign and Malignant Skin Lesions

L33813 — Destruction of Malignant Skin Lesions

REGENCE-SUR132 — Cryosurgical Ablation of Miscellaneous Solid Tumors Outside of the Liver

Ask Verity about documentation requirements, denial risks, or coverage in your state.