Summary & Overview

CPT 11620: Excision of Malignant Skin Lesion, Scalp, Neck, Hands, Feet, Genitalia

CPT code 11620 is a nationally recognized billing code for the surgical excision of malignant skin lesions, including margins, from sensitive anatomical sites such as the scalp, neck, hands, feet, and genitalia. This procedure is essential in the treatment of skin cancers, including malignant melanoma and Merkel cell carcinoma, and is performed by dermatologists, surgeons, and family medicine practitioners. The code is widely accepted by major payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, reflecting its importance in clinical practice and reimbursement policies.

This publication provides a comprehensive overview of 11620, covering payer coverage, clinical context, and related coding benchmarks. Readers will gain insight into typical sites of service, common clinical indications, and associated procedures. The summary also highlights relevant modifiers and taxonomies, offering clarity on coding nuances and policy updates. By understanding the scope and application of 11620, stakeholders can better navigate billing practices and stay informed about evolving standards in dermatologic surgery.

AetnaBlue Cross Blue ShieldCigna HealthMedicareUnitedHealthcareCPT 11620dermatologymalignant lesion excisionsurgical procedureskin cancerambulatory surgical centeroffice settingclinical codingpolicy updatebenchmark

CPT Code Overview

CPT code 11620 describes the excision of a malignant lesion, including margins, from areas such as the scalp, neck, hands, feet, or genitalia. This procedure is classified as a surgical dermatologic intervention and is typically performed in an ambulatory surgical center or office setting. The excision is a critical step in the management of skin cancers and other malignant lesions, ensuring complete removal and reducing the risk of recurrence. The procedure is commonly utilized by specialists in dermatology, surgery, and family medicine.

Clinical & Coding Specifications

Clinical Context

A patient presents to a dermatology or surgical clinic with a suspicious skin lesion located on the scalp, neck, hands, feet, or genitalia. After clinical evaluation and possible biopsy, the lesion is diagnosed as malignant, such as malignant melanoma or Merkel cell carcinoma. The provider determines that surgical excision is necessary to remove the lesion, including appropriate margins to ensure complete removal. The procedure is typically performed in an ambulatory surgical center or office setting. Post-excision, the wound may require closure, and pathology is used to confirm clear margins. The workflow may involve preoperative assessment, excision, wound management, and follow-up for pathology results and further care as needed.

Coding Specifications

Modifier 59: Used to indicate a distinct procedural service, such as when multiple lesions are excised in separate anatomical locations or when the excision is performed in conjunction with another unrelated procedure.
Modifier 51: Used to denote multiple procedures performed during the same session, such as excision of more than one malignant lesion.

Taxonomy Code	Specialty Name
`207N00000X`

National Reimbursement Benchmarks

Medicare's national mean rate for CPT code 11620 is $205.94, which is slightly below the BUCA (average commercial) mean rate of $208.14. Commercial payers such as UnitedHealth Group and Cigna have notably higher mean rates, at $287.91 and $262.40 respectively, compared to both Medicare and BUCA.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare exhibits the tightest range at $22.00, indicating relatively consistent reimbursement rates. In contrast, UnitedHealth Group shows the widest dispersion at $171.00, reflecting greater variability in commercial rates. Blue Cross Blue Shield and Cigna also display substantial ranges, at $93.00 and $154.00 respectively.

The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.

National Mean Rates by Payer for CPT Code `11620`

Related Diagnoses

C43.4: Malignant melanoma of scalp and neck
- Relevant for excision of melanoma located on the scalp or neck.
C43.60: Malignant melanoma of unspecified upper limb, including shoulder
- Used when the malignant lesion is on the upper limb or shoulder, but the exact side is not specified.
C43.61: Malignant melanoma of right upper limb, including shoulder
- Indicates melanoma on the right upper limb or shoulder; excision may be performed on the hand.
C43.62: Malignant melanoma of left upper limb, including shoulder
- Indicates melanoma on the left upper limb or shoulder; excision may be performed on the hand.
C43.70: Malignant melanoma of unspecified lower limb, including hip
- Used for melanoma on the lower limb or hip, side unspecified; excision may be performed on the foot.
C43.71: Malignant melanoma of right lower limb, including hip
- Indicates melanoma on the right lower limb or hip; excision may be performed on the foot.
C43.72: Malignant melanoma of left lower limb, including hip
- Indicates melanoma on the left lower limb or hip; excision may be performed on the foot.
C4A.4: Merkel cell carcinoma of scalp and neck
- Relevant for excision of Merkel cell carcinoma located on the scalp or neck.
C4A.51: Merkel cell carcinoma of anal skin
- Used for excision of Merkel cell carcinoma on the anal skin, which may be considered part of the genitalia for coding purposes.

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Summary & Overview

CPT 11620: Excision of Malignant Skin Lesion, Scalp, Neck, Hands, Feet, Genitalia

CPT Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

National Reimbursement Benchmarks

Related Codes

Related Diagnoses

Related CPT Codes

National Reimbursement Benchmarks

Related Codes