$71.76
Use 17000, adding 17003 for lesions two through fourteen, when fewer than 15 premalignant lesions are destroyed. Use 17004 alone when the count reaches 15.
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CMS RVU26D · Effective 2026-10-01
17004 Premalignant lesion destruction Medicare reimbursement rates in Hawaii
Destruction of 15 or more premalignant skin lesions, most often actinic keratoses, at one session, reported as a single unit instead of 17000 and 17003. Compare 17004 office and facility rates across CMS payment localities in Hawaii.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 17004 in Hawaii?
Hawaii has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$176.01
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
Facility setting
$85.63
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Dermatology procedure
About 17004: Destruction of 15 or more premalignant skin lesions
Destruction of 15 or more premalignant skin lesions, most often actinic keratoses, at one session, reported as a single unit instead of 17000 and 17003.
This service covers destroying 15 or more premalignant skin lesions in one session. A typical case involves numerous actinic keratoses on the face, scalp, ears, forearms, or hands. Dermatologists, primary care physicians, and advanced practice clinicians perform it, most often in the office. Liquid nitrogen cryosurgery is the usual method. Curettement, electrosurgery, chemical destruction, and laser are also methods of destruction. Count the premalignant lesions treated during the session, regardless of their locations.
When 15 or more lesions are treated, report one unit of 17004, not 17000 or 17003. For fewer lesions, report 17000 for the first and one unit of 17003 for each additional lesion through the fourteenth. Documentation should state the count, anatomic locations, diagnosis, and destruction method. The procedure has a 10-day global period, which includes related postoperative visits during those 10 days. Modifier 50 is inappropriate even when lesions are treated on both sides of the body. CMS does not pay an assistant at surgery; co-surgeons and team surgery are not permitted.
CMS billing rules for 17004
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days are included.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU1.34 · 28%
- Practice expense (office) RVU3.39 · 70%
- Malpractice RVU0.13 · 3%
852.8K
Medicare services in 2024 · #159 by national volume
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
17004 compared with similar codes
Office rates for Hawaii, from the same CMS release.
$7.03
17003 is reported per additional lesion for lesions two through fourteen, with 17000. At 15 or more lesions, report one unit of 17004 instead.
$122.05
17110 covers benign lesions such as common warts and molluscum. Actinic keratoses and other premalignant lesions belong in the 17000–17004 series.
$104.34
The 17260 series covers destruction of malignant lesions and is selected by lesion diameter and anatomic site. Code 17004 covers premalignant lesions and is selected by count, not size.
Compare 17004 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Hawaii, Guam →
Office / nonfacility
$176.01
Facility
$85.63
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 17004 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
1,621
- Code
- 17004
- Physician work
- 1.34
- Practice expense
- 3.39
- Malpractice
- 0.13
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.34 | × 1.000 | 1.3400 |
| Practice expense | 3.39 | × 1.137 | 3.8544 |
| Malpractice | 0.13 | × 0.579 | 0.0753 |
| Total RVUs | 5.2697 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Hawaii, Guam$176.01
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.34 | 1 |
| Practice expense | 3.39 | 1.137 |
| Malpractice | 0.13 | 0.579 |
(1.34 × 1 + 3.39 × 1.137 + 0.13 × 0.579) × $33.4009 = $176.01
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.34 | 1 |
| Practice expense | 1.01 | 1.137 |
| Malpractice | 0.13 | 0.579 |
(1.34 × 1 + 1.01 × 1.137 + 0.13 × 0.579) × $33.4009 = $85.63
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
17004 billing questions
How many units of 17004 are reported if 30 actinic keratoses are destroyed?
One unit. This code covers 15 or more lesions in a single session regardless of how many above that threshold are treated.
Can 17000 and 17003 be reported along with 17004?
No. At 15 or more premalignant lesions in a session, 17004 replaces the 17000 and 17003 combination. Reporting them together would duplicate the lesion destruction.
Can an E/M visit be billed on the same day?
Yes, if the E/M service is significant and separately identifiable from the usual assessment for this minor procedure, such as evaluation of an unrelated problem. Append modifier 25 to the E/M code; the routine decision to destroy the lesions is included in the procedure.
Is a biopsy of a different lesion separately reportable?
Yes, when a separate suspicious lesion is biopsied rather than destroyed. Report the appropriate biopsy code, such as 11102 for a tangential biopsy; use modifier 59 or XS when an edit requires a distinct-service modifier, and document both lesions.
Should the treated lesions be listed by location?
Yes. Record the total count and anatomic sites, such as the face, scalp, and dorsal hands, so the 15-lesion threshold can be verified.
What if photodynamic therapy is used instead of conventional destruction?
For physician- or qualified-health-care-professional-performed photodynamic therapy with application and activation of a photosensitizing drug, report 96573 instead. Report 96574 when that service also includes debridement of hyperkeratotic premalignant lesions.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
1,61816036,,Escharotomy ea addl incision,A,,1.46,0.38,NA,0.38,,0.36,2.20,2.20,0,ZZZ,0.00,0.00,0.00,0,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,61917000,,Destruct premalg lesion,A,,0.59,1.34,,0.78,,0.06,1.99,1.43,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,62017003,,Destruct premalg les 2-14,A,,0.04,0.15,,0.01,,0.00,0.19,0.05,0,ZZZ,0.00,0.00,0.00,0,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,62117004,,Destroy premal lesions 15/>,A,,1.34,3.39,,1.01,,0.13,4.86,2.48,0,010,0.10,0.80,0.10,0,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,62217106,,Dstr cut vsc prlf les<10sqcm,A,,3.60,6.22,,3.15,,0.42,10.24,7.17,0,090,0.10,0.71,0.19,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,62317107,,Dstr cut vsc prlf les10-50sq,A,,4.67,8.10,,4.09,,0.49,13.26,9.25,0,090,0.10,0.71,0.19,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,62417108,,Dstr cut vsc prlf les>50sqcm,A,,7.30,10.72,,5.37,,0.91,18.93,13.58,0,090,0.10,0.71,0.19,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014