Incision and drainage of abscess; complicated or multiple

CPT 10061 is the billing code for "Incision and drainage of abscess; complicated or multiple". For complicated or multiple abscess drainage requiring extensive procedure

Medicare pays approximately $208.31 for CPT 10061 (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 10061 has a total RVU of 8.35, broken down as: Work RVU 3.50, Practice Expense RVU 4.50, and Malpractice RVU 0.35. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 10061 include: Location and number of abscesses; Complexity of drainage; Extent of tissue involvement; Amount of purulent material. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 10061: Includes incision and drainage. Includes local anesthesia Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 10061 include: 51 (Multiple procedures performed same session), 59 (Distinct procedural service if performed separately), LT (Left side procedure). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

The typical time requirement for CPT 10061 is 20-40 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.