Acne surgery (e.g., marsupialization, opening or removal of multiple milia, comedones, pustules, or cysts)

CPT 10040 is the billing code for "Acne surgery (e.g., marsupialization, opening or removal of multiple milia, comedones, pustules, or cysts)". Acne surgery including extraction of comedones, milia, pustules, or cysts

Medicare pays approximately $112.57 for CPT 10040 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.

CPT 10040 has a total RVU of 1.14, broken down as: Work RVU 0.50, Practice Expense RVU 0.60, and Malpractice RVU 0.04. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 10040 include: Number of lesions treated documented; Location of lesions documented; Method of extraction documented; Patient response to treatment. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 10040: Includes multiple lesions in one session. May include comedones, milia, pustules, or cysts Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 10040 include: 59 (Distinct procedural service when multiple procedures performed), 51 (Multiple procedures performed). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

The typical time requirement for CPT 10040 is Typically 15-30 minutes. Time-based codes require documentation of the actual time spent providing the service.