Puncture aspiration of abscess, hematoma, bulla, or cyst

CPT 10160 is the billing code for "Puncture aspiration of abscess, hematoma, bulla, or cyst". Puncture aspiration of abscess, hematoma, bulla, or cyst using needle aspiration

Medicare pays approximately $126.47 for CPT 10160 (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 10160 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 10160 include: Location of lesion documented; Method of aspiration documented; Amount aspirated documented; Patient response to treatment. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 10160: Puncture aspiration only. Does not include incision Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 10160 include: 59 (Distinct procedural service when multiple procedures performed), 50 (Bilateral procedure). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

The typical time requirement for CPT 10160 is Typically 10-20 minutes. Time-based codes require documentation of the actual time spent providing the service.