Summary & Overview
CPT 11055: Removal of Single Benign Hyperkeratotic Lesion
CPT code 11055 designates the surgical removal of a single benign hyperkeratotic lesion using instruments such as a scalpel or curette. This code captures a common, low-complexity dermatologic procedure performed in outpatient settings. Nationally, accurate reporting of this code affects procedure tracking, utilization monitoring, and appropriate payment for minor skin surgery.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise briefing on clinical context, typical sites of service, and common billing modifiers that may accompany this procedure (modifier list provided separately). The publication summarizes benchmark metrics where available, highlights coding and documentation considerations, and outlines policy updates or payer guidance relevant to minor dermatologic excisions.
This overview is intended for billing professionals, dermatology and primary care clinicians, and policy analysts seeking a clear understanding of the code’s clinical meaning, expected care settings, and implications for national billing practices. Data not available in the input will be noted explicitly in the detailed sections.
Billing Code Overview
CPT code 11055 describes the removal of a single benign hyperkeratotic lesion using surgical instruments such as a scalpel or curette. This procedure is a minor surgical service directed at excising superficial, nonmalignant keratotic skin growths.
-
Service type: Minor surgical excision of a benign skin lesion
-
Typical site of service: Office-based dermatology or primary care procedure room, outpatient clinic, or ambulatory surgical setting
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to an outpatient dermatology or primary care clinic with a single benign hyperkeratotic lesion such as a common wart, corn, callus, or seborrheic keratosis causing pain, irritation, or cosmetic concern. After history and focused skin exam, the provider documents lesion size, location, duration, and prior treatments. Local anesthesia (topical or local infiltration) is often administered. The provider uses a scalpel, curette, or scissors to shave or curette the lesion down to a normal skin plane and achieves hemostasis with chemical cautery or electrocautery as needed. The procedure is typically completed during the same visit, with aftercare instructions provided and, if indicated, a specimen sent for pathology. Typical site of service is an outpatient clinic, dermatology office, ambulatory surgical center, or primary care office. Clinical workflow includes consent, anesthesia, procedure, hemostasis, dressing, and documentation of lesion characteristics and method of removal.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable E/M service by the same physician on the day of a procedure | Use when a distinct evaluation and management visit is performed in addition to 11055 on the same date. |
59 | Distinct procedural service | Use to indicate a distinct procedural service when multiple procedures are performed on the same day and not normally reported together. |
52 | Reduced services | Use when the procedure is partially reduced or not completed as described by the full CPT code. |
53 | Discontinued procedure | Use when the procedure is started but terminated due to extenuating circumstances. |
50 | Bilateral procedure | Use when the same procedure is performed bilaterally; some payors require bilateral reporting modifiers. |
76 | Repeat procedure by same physician | Use when the same procedure is repeated by the same physician later the same day (note: 76/77 not in provided list; not used here). |
59 | Distinct procedural service | Duplicate entry avoided — see above. |
51 | Multiple procedures | Use when multiple procedures are performed the same session; report additional procedures with reduced reimbursement per payor rules. |
22 | Increased procedural services | Use when work required is substantially greater than typically required. |
52 | Reduced services | Duplicate avoided — see above. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207Q00000X | Dermatology | Dermatologists commonly perform lesion removal using curettage or scalpel. |
| 207L00000X | Family Medicine | Family physicians frequently remove benign skin lesions in office settings. |
| 207P00000X | Internal Medicine | General internists perform minor skin procedures in outpatient clinics. |
| 283Q00000X | General Surgery | General surgeons may remove cutaneous lesions in ambulatory or office-based settings. |
| 207W00000X | Pediatric Medicine | Pediatricians may perform lesion removal for children when appropriate. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
L84 | Corns and callosities | Common benign hyperkeratotic lesions treated with curettage or scalpel removal. |
B07.9 | Viral warts, unspecified | Common wart lesions often hyperkeratotic and removed for symptoms or refractory to topical therapy. |
L21.0 | Seborrheic dermatitis of scalp | May include hyperkeratotic scaling lesions; less commonly targeted by 11055 but relevant for differential. |
L85.3 | Acquired ichthyosis | Can produce hyperkeratotic areas; occasionally managed with debridement. |
L82.1 | Solar keratosis (actinic keratosis) | Hyperkeratotic premalignant lesions sometimes treated with removal; biopsy recommended when suspicious. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
11102 | Tangential biopsy of skin (single lesion); trunk, arms or legs; shave, single lesion | Used for diagnostic biopsy of a suspicious epidermal lesion prior to or instead of complete removal. |
11100 | Tangential biopsy of skin (single lesion); face, ears, eyelids, nose, lips; shave, single lesion | Alternative shave biopsy code for lesions in cosmetically sensitive areas. |
12001 | Simple repair of superficial wounds (2.5 cm or less) | May be reported if a separate simple wound repair is performed after lesion removal. |
13100 | Repair of complex wounds (face, ears, eyelids, nose, lips) | Used when closure after lesion removal requires complex layered repair in cosmetically sensitive areas. |
11107 | Tangential biopsy, up to 15 lesions | Related when multiple shave biopsies or removals are performed in the same session. |