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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.
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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.
National Reimbursement Benchmarks
Medicare's mean rate for CPT 11403 sits at $206.50, substantially lower than BUCA's average commercial mean of $656.10. This gap of $449.60 highlights a sizable separation between federal reimbursement and this commercial benchmark, with Medicare concentrated around its interquartile band ($193–$214) while BUCA’s central tendency is notably higher at a median of $700.70.
Dispersion measured as the P75–P25 spread varies across payers: Blue Cross Blue Shield shows the widest IQR at $912.70 (P75 $1,325.40 minus P25 $432.70), indicating significant variability in negotiated rates, followed by Aetna with a spread of $119.50 and UnitedHealth Group at $190.30. Cigna’s spread is $157.80 and BUCA’s IQR is $595.80. Medicare’s interquartile range is tightest at $21.00, reflecting the most compressed distribution among listed payers.