Summary & Overview
CPT 11606: Excision of Malignant Skin Lesion, Over 4.0 cm, Trunk/Arms/Legs
CPT code 11606 represents the excision of a malignant skin lesion, including margins, from the trunk, arms, or legs, with an excised diameter greater than 4.0 cm. This procedure is a critical component of dermatologic and surgical care for patients with large malignant lesions, such as melanoma, and is commonly performed by specialists in dermatology and surgery. Nationally, this code is recognized by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, ensuring broad coverage for patients undergoing this procedure.
This publication provides a comprehensive overview of CPT 11606, including payer coverage, clinical context, and related billing considerations. Readers will gain insight into the clinical indications for the code, typical use cases, and associated diagnoses such as malignant melanoma of various skin sites. The summary also highlights relevant modifiers and taxonomies, offering clarity on how this code fits within broader billing and policy frameworks. Key benchmarks and policy updates are discussed to inform stakeholders about current trends and requirements for accurate reporting and reimbursement. The information is organized to support healthcare professionals, billing specialists, and policy analysts in understanding the national landscape for this high-complexity skin excision procedure.
CPT Code Overview
CPT 11606 is used to report the excision of a malignant skin lesion, including margins, from the trunk, arms, or legs, where the excised diameter is over 4.0 cm. This code falls under surgical procedures on the skin (Integumentary Surgery). The typical site of service for this procedure is not specified in the available data. This code is significant for clinicians and billing professionals managing cases involving large malignant skin lesions requiring surgical removal.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult presenting to a dermatology or surgical clinic with a suspicious skin lesion on the trunk, arms, or legs. The lesion is clinically diagnosed as malignant, such as malignant melanoma, and measures over 4.0 cm in excised diameter. The provider performs a surgical excision of the lesion, including appropriate margins, to ensure complete removal. The procedure is commonly performed by dermatologists, MOHS surgeons, or general surgeons, and may occur in an outpatient surgical suite or ambulatory setting. Postoperative care includes wound management and pathology review to confirm clear margins.
Coding Specifications
-
Modifier
59: Distinct Procedural Service. Used when a procedure or service is distinct or independent from other services performed on the same day. -
Modifier
51: Multiple Procedures. Used when multiple procedures are performed during the same session by the same provider.
| Modifier Code | Description |
|---|---|
59 | Distinct Procedural Service |