Summary & Overview
CPT 11403: Excision of Benign Skin Lesion, 2.1–3.0 cm, Trunk/Arms/Legs
CPT code 11403 represents the surgical excision of a benign (noncancerous) skin lesion, excluding skin tags, with an excised diameter of 2.1 to 3.0 cm on the trunk, arms, or legs. This code captures a commonly performed dermatologic and minor surgical service that affects outpatient and ambulatory surgical workflows and payment processes nationwide. Accurate coding ensures appropriate clinical documentation, billing, and claims adjudication for lesion removals that exceed smaller-size categories.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication reviews national benchmarks, payer coverage considerations, clinical context for lesion excision sizing and site of service, and coding relationships to adjacent excision codes for smaller and larger lesions.
Readers will learn: the clinical scope and typical settings for 11403; how this code relates to nearby CPT excision codes for benign lesions; common payer coverage patterns and considerations; and the documentation elements that support correct code selection. The content provides practical policy and billing context relevant to dermatology, family medicine, and surgical practices handling benign skin lesion excisions. Data not available in the input is explicitly omitted.
Billing Code Overview
CPT code 11403 describes the surgical excision of a benign (noncancerous) skin lesion, excluding skin tags, with an excised diameter of 2.1 to 3.0 cm including margins. The procedure is performed on the skin of the trunk, arms, or legs and involves removal of the lesion with appropriate surgical margins.
Service type: Surgical excision of benign skin lesion
Typical site of service: Outpatient procedure setting or ambulatory surgical center; can also be performed in clinic-based procedure rooms depending on clinical practice and facility capabilities.
Clinical & Coding Specifications
Clinical Context
A 58-year-old female presents to a dermatology clinic with a slowly enlarging, well-circumscribed, nonpigmented papule on the lateral trunk measuring approximately 2.5 cm in greatest diameter. The lesion is clinically suspicious for a benign epidermal inclusion cyst or a squamous proliferative lesion and prior shave biopsy returned pathology consistent with carcinoma in situ of the skin. The dermatologist schedules a planned outpatient excision under local anesthesia to remove the lesion with margins. The encounter includes preoperative assessment, informed consent, local infiltration with anesthetic, complete excision of the lesion including margins measuring 2.1–3.0 cm, hemostasis, layered closure, and specimen submission to pathology. Typical site of service is an ambulatory surgical center or hospital outpatient department; the procedure may also occur in a dermatology office procedure room equipped for minor surgical excisions. Relevant documentation includes lesion location (trunk, arms or legs), measured excised diameter, indication/diagnosis (D07.1 or relevant N90.*), operative technique, anesthesia type, and specimen disposition.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | Use when the excised lesion is on the left side of the body (e.g., left trunk or left arm). |