Summary & Overview
CPT 11401: Excision of Benign Skin Lesion, Trunk/Arms/Legs
CPT code 11401 represents the surgical excision of a noncancerous skin lesion, excluding skin tags, measuring 0.6 to 1.0 cm in diameter (including margins) from the trunk, arms, or legs. This procedure code is widely used across ambulatory surgical centers, dermatology clinics, and physician offices and is important for ensuring consistent reporting and payment for common minor skin surgeries performed in outpatient settings. Nationally, appropriate coding for these procedures affects practice revenue, quality reporting, and claims adjudication.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines the clinical context for use of CPT code 11401, typical sites of service, and common billing considerations.
Readers will learn how CPT code 11401 is defined clinically, where it is typically reported, and what operational elements influence its use. The report provides benchmark-oriented coverage insights and policy-relevant details that affect claims processing and administrative workflows. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 11401 describes the excision of a benign (noncancerous) skin lesion, excluding skin tags, measuring 0.6 to 1.0 cm in diameter (including margins). The procedure involves surgical removal of the lesion with appropriate margins and closure as indicated.
Service Type: Surgical excision of skin lesion
Typical Site of Service: Skin of the trunk, arms, or legs
Clinical & Coding Specifications
Clinical Context
A 45-year-old patient presents to an outpatient dermatology clinic with a solitary, benign-appearing papule on the lateral forearm that has slowly enlarged over several months and intermittently catches on clothing. After clinical evaluation and counseling, the dermatologist schedules an excision of the lesion under local anesthesia. The procedure includes marking margins, preparing the skin with antiseptic, injecting local anesthetic (e.g., 1% lidocaine with epinephrine), performing an elliptical excision with complete removal of the lesion and margin measuring between 0.6 and 1.0 cm in diameter, achieving hemostasis, and closing the defect with layered suturing as needed. The specimen is submitted to pathology if clinically indicated. Typical documentation includes lesion location, size (including margins), estimated wound size, anesthesia administered, technique, closure method, specimen disposition, and postoperative instructions.
Typical site of service: outpatient dermatology clinic, ambulatory surgical center, or physician office procedural room.
Service type: minor surgical excision of a benign cutaneous lesion on the trunk, arms, or legs performed under local anesthesia.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the day of the procedure | Use when a separate E/M is performed and documented in addition to the excision visit. |
50 | Bilateral procedure | Use when substantially identical lesions on both sides are excised during the same session. |
52 | Reduced services | Use when the excision is partially reduced or not completed as planned. |
53 | Discontinued procedure | Use when the procedure is started but halted due to extenuating circumstances. |
59 | Distinct procedural service | Use when a separate, distinct procedure is performed at a different anatomical site the same day. |
76 | Repeat procedure by same physician | Use when the same procedure is repeated by the same provider within the global period. |
77 | Repeat procedure by another physician (not in raw list) | Data not provided in input. |
LT | Left side | Use to indicate the procedure was performed on the left extremity or left side of trunk. |
RT | Right side | Use to indicate the procedure was performed on the right extremity or right side of trunk. |
59 | Distinct procedural service | Use when another procedure is separate and distinct from the excision (keeps coded for emphasis). |
26 | Professional component | Use when reporting only the professional component of a service when the technical component is billed separately. |
TC | Technical component | Use when reporting only the technical component of a service when the professional component is billed separately. |
GA | Waiver of liability statement on file (preauthorization) | Use when the payer has waived liability requirements due to payer policy exception. |
GZ | Item or service expected to be denied as not reasonable and necessary | Use when the service is provided and likely noncovered; documentation should support medical necessity. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207N00000X | Dermatology | Most common specialty performing skin lesion excisions. |
| 207RN0400X | Family Medicine | Primary care physicians commonly perform minor skin excisions in office. |
| 208D00000X | General Surgery | Surgeons perform excisions for larger or complex lesions on trunk and extremities. |
| 208000000X | Internal Medicine | Hospitalists or internists may perform simple excisions in some outpatient settings. |
| 2084P0800X | Plastic Surgery | Plastic surgeons manage excisions requiring complex closures or cosmetic reconstruction. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
L91.8 | Other hypertrophic disorders of skin | Benign skin growths that may be excised for symptoms or cosmesis. |
L98.9 | Disorder of skin and subcutaneous tissue, unspecified | General code used when a more specific benign lesion diagnosis is not assigned. |
D22.9 | Melanocytic nevi, unspecified | Common benign nevus that may be removed if symptomatic or for diagnostic purposes. |
L70.9 | Acne, unspecified | Excisions occasionally performed for cystic lesions or nodules refractory to therapy. |
L92.8 | Other granulomatous disorders of skin and subcutaneous tissue | Granulomatous nodules may require excision for diagnosis or symptom relief. |
L98.0 | Pyogenic granuloma | Common vascular-appearing benign lesion often removed by excision. |
Z48.00 | Encounter for removal of sutures | Postoperative follow-up code related to wound care after excision. |
Z09 | Encounter for follow-up examination after completed treatment of conditions other than malignant neoplasm | Used for routine post-procedure follow-up when indicated. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
11102 | Tangential biopsy of skin (shave), single lesion | Performed when a shave biopsy is chosen instead of full-thickness excision for superficial lesions. |
11107 | Tangential biopsy of skin, each additional lesion (list separately) | Used when multiple shave biopsies are performed during the same encounter. |
12032 | Repair, intermediate, wounds of trunk, arms, legs; 2.6 cm to 7.5 cm | Used for more complex layered closures following excision when wound length falls within this range. |
13132 | Repair, complex, trunk, arms, legs; 2.6 cm to 7.5 cm | Used when excision requires complex repair techniques beyond intermediate closure. |
99213 | Office or other outpatient visit for evaluation and management, established patient, low to moderate complexity | Frequently billed on the same day when an E/M service is separately documented (use 25 if applicable). |
88305 | Level IV surgical pathology, gross and microscopic examination | Used when the excised specimen is sent to pathology for histologic evaluation. |