Paring or cutting of benign hyperkeratotic lesion (e.g., corn or callus), single lesion

CPT 11055 is the billing code for "Paring or cutting of benign hyperkeratotic lesion (e.g., corn or callus), single lesion". Paring or cutting of single benign hyperkeratotic lesion such as corn or callus

Medicare pays approximately $67.93 for CPT 11055 (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 11055 has a total RVU of 0.57, broken down as: Work RVU 0.25, Practice Expense RVU 0.30, and Malpractice RVU 0.02. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 11055 include: Location of lesion documented; Type of lesion documented; Method of paring documented; Patient response to treatment. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 11055: Single lesion only. Use 11056 for 2-4 lesions Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 11055 include: 59 (Distinct procedural service when multiple procedures performed), 50 (Bilateral procedure), LT (Left side). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

The typical time requirement for CPT 11055 is Typically 5-10 minutes. Time-based codes require documentation of the actual time spent providing the service.