Summary & Overview
CPT 11403: Excision of Benign Skin Lesion, Trunk/Arms/Legs (2.1–3.0 cm)
CPT 11403: Excision of Benign Lesion, Trunk, Arms or Legs (2.1–3.0 cm)
CPT code 11403 is a widely utilized billing code for the surgical excision of benign skin lesions, excluding skin tags, from the trunk, arms, or legs, with an excised diameter between 2.1 and 3.0 centimeters. This procedure is a routine component of dermatologic and surgical care, performed in both office and hospital outpatient settings. Accurate coding is essential for proper reimbursement and clinical documentation, making CPT 11403 significant for providers, payers, and patients nationwide.
Major national payers covering this procedure include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. The publication provides a comprehensive overview of payer coverage, policy updates, and clinical benchmarks relevant to CPT 11403. Readers will gain insight into the procedure’s clinical context, typical sites of service, and its role in the management of benign skin lesions. The summary also highlights associated modifiers, provider taxonomies, and related ICD-10 diagnoses, offering a clear understanding of coding requirements and payer expectations.
This article serves as a resource for healthcare professionals, administrators, and policy analysts seeking up-to-date information on CPT 11403, including payer coverage, coding nuances, and clinical applications. It supports informed decision-making in medical billing, compliance, and patient care.
CPT Code Overview
CPT 11403 describes the excision of a benign lesion, including margins, except skin tag, from the trunk, arms, or legs, with an excised diameter of 2.1 to 3.0 cm. This procedure is part of the Integumentary System and is classified as dermatologic surgery. It is commonly performed in an office setting (POS 11) or a hospital outpatient facility (POS 19). The code is used to document and bill for the surgical removal of benign skin lesions, ensuring accurate reporting for both clinical and reimbursement purposes.
Clinical & Coding Specifications
Clinical Context
A patient presents to a dermatology or family medicine clinic with a benign skin lesion on the trunk, arm, or leg. The lesion measures between 2.1 and 3.0 cm in diameter. After clinical evaluation, the provider determines that excision is appropriate to remove the lesion, including a margin of normal tissue. The procedure is performed in an office or hospital outpatient setting. The excised tissue is sent for pathology to confirm benign status. Documentation includes lesion size, location, and excision technique.
Coding Specifications
Modifiers:
| Modifier Code | Description | When Used |
|---|---|---|
50 | Bilateral procedure | When the procedure is performed on both sides of the body |
80 | Assistant surgeon | When an assistant surgeon is required |
82 | Assistant surgeon when qualified resident surgeon not available | When no qualified resident is available and an assistant surgeon is needed |
51 | Multiple procedures | When multiple procedures are performed during the same session |
62 | Co-surgeon | When two surgeons perform distinct parts of the procedure |
26 | Professional component | When only the professional component is billed (if applicable) |
Provider Taxonomies:
207N00000X— Dermatology Physician (specializes in skin conditions and procedures)207Q00000X— Family Medicine Physician (provides general medical care including minor skin procedures)208600000X— Surgery Physician (performs surgical procedures including skin excisions)
Related Diagnoses
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D07.1— Carcinoma in situ of skin of other and unspecified parts of trunk- Relevant when excising lesions suspected to be carcinoma in situ on the trunk. Ensures proper documentation for excision of potentially pre-cancerous lesions.
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N90.0— Vulvar intraepithelial neoplasia, grade I [low grade]- Used when excising benign or low-grade neoplastic lesions of the vulva. Indicates the clinical reason for excision.
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N90.1— Vulvar intraepithelial neoplasia, grade II [moderate grade]- Applied for moderate-grade neoplastic lesions of the vulva requiring excision.
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N90.3— Vulvar intraepithelial neoplasia, grade III [severe grade]- Used for severe-grade neoplastic lesions of the vulva. Supports medical necessity for excision.
Related CPT Codes
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11400— Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less- Used for smaller lesions (<0.5 cm) on the same anatomical sites. Often an alternative to
11403for smaller lesions.
- Used for smaller lesions (<0.5 cm) on the same anatomical sites. Often an alternative to
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11402— Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 1.1 to 2.0 cm- Used for lesions measuring 1.1 to 2.0 cm. May be used in the same workflow for multiple lesions of varying sizes.
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11443— Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter > ? cm- Used for excision of benign lesions on the face or mucous membranes. Not typically used together with
11403unless multiple lesions are excised from different anatomical sites.
- Used for excision of benign lesions on the face or mucous membranes. Not typically used together with
National Reimbursement Benchmarks
For CPT code 11403, the national mean rate for Medicare is $206.54, while the average commercial mean rate (BUCA) is $219.32. Commercial payers such as UnitedHealth Group and Cigna have notably higher mean rates, at $301.35 and $283.11 respectively, compared to both Medicare and BUCA.
Rate dispersion, measured as the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare shows the tightest range ($21.00), indicating less variability in rates. In contrast, UnitedHealth Group and Cigna exhibit the widest dispersions ($184.67 and $166.00 respectively), reflecting greater variability in commercial reimbursement levels.
The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.