Excision of Malignant Lesion — Complicated (D7415) — National Rates

About D7415 — Excision of Malignant Lesion — Complicated

D7415 refers to the excision of a malignant lesion that is considered complicated. This procedure typically involves the surgical removal of cancerous tissue from the oral cavity, which may require more extensive techniques due to the lesion's size, location, or involvement with surrounding structures. Clinical indications for this procedure include the presence of malignant lesions that necessitate surgical intervention to prevent further complications or metastasis. Documentation for billing should include detailed notes on the lesion's characteristics, the surgical approach used, and any complications encountered during the procedure. Reimbursement for D7415 can vary significantly by payor and state, with average payments around $370. Some insurance plans may have specific criteria for coverage, which can affect the final reimbursement amount. It is essential to verify the patient's benefits and obtain pre-authorization when necessary to ensure proper payment.

Reimbursement rates for D7415 vary significantly by state, payor, and provider network. The national average negotiated rate is $370. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.