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    OpenPayerBilling CodesExcision-Benign Lesions Procedures on the SkinCPT cpt-11403-excision-benign-lesion-trunk-arms-legs-2-1-3-0-cm
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    CPT 11403: Excision of Benign Lesion, Trunk/Arms/Legs 2.1–3.0 cm

    Medicare pays $207 and commercial payers pay $656 on average nationally for this procedure.

    CPT code 11403 describes 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 a surgical excision typically performed in an outpatient clinic, ambulatory surgery center, or office-based minor procedure setting on the trunk, arms, or legs.

    For related coverage guidance, see recent payer policy updates: Mohs Micrographic Surgery, Mohs Micrographic Surgery, Mohs Micrographic Surgery.

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    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.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    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.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    11400Excision, benign lesion including margins, except skin tag, trunk, arms or legs; excised diameter 0.5 cm or less

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    57CPT® modifier -57 (“Decision for Surgery”) is appended to an Evaluation and Management (E/M) service when that encounter results in the initial decision to perform a major surgery (a procedure with a…- Use modifier 57 when an E/M service provided by the same provider (or same tax ID) on the day of or the day before a major surgical procedure (90‑day global period) results in the initial decision…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207N00000X
    207Q00000X
    208600000X
    225800000X
    111NN1001X
    207PT0002X
    273100000X
    253J00000X

    Related ICD-10-CM Codes

    32 rows

    ICD-10-CM CodeDescription
    B07.8Other viral warts
    B07.9Viral wart, unspecified
    D07.1Carcinoma in situ of vulva
    D22.5Melanocytic nevi of trunk
    D22.9Melanocytic nevi, unspecified
    D23.4Other benign neoplasm of skin of scalp and neck
    D23.5Other benign neoplasm of skin of trunk
    D23.9Other benign neoplasm of skin, unspecified
    I83.10Varicose veins of unspecified lower extremity with inflammation
    I83.90Asymptomatic varicose veins of unspecified lower extremity

    Showing 1–10 of 32

    Related Payer Policy Updates

    Specialty: Dermatology1 / 3

    10 rows

    PolicyPayerEffective Date
    Mohs Micrographic Surgerypremerabluecrossofwashington2027-02-05
    Mohs Micrographic Surgerypremerabluecrossofwashington2027-02-05
    Mohs Micrographic Surgerypremerabluecrossofwashington2027-02-05
    FilsuvezCigna2026-11-01
    Destruction of Pre-Malignant Skin LesionsAnthem2026-10-01
    Onychomycosis diagnostic testing and coverageOscar Health2026-10-01
    Treatment of Capillary Malformations (Port Wine Stains)universityofutahhealthplans2026-09-28
    AnzupgoCigna2026-09-15
    Hyperhidrosispriority_health_medicare2026-09-01
    Zevaskyn Coverage for Recessive Dystrophic Epidermolysis BullosaCigna2026-09-01

    Related Codes

    CPT-11400-EXCISION-BENIGN-LESION-TRUNK-ARMS-LEGS-05-CM-OR-LESS

    CPT 11400: Excision of Benign Lesion, Trunk/Arms/Legs, ≤0.5 cm

    CPT-11401-EXCISION-BENIGN-SKIN-LESION-TRUNK-ARMS-LEGS-0-6-1-0-CM

    CPT 11401: Excision of Noncancerous Skin Lesion 0.6–1.0 cm

    CPT-11402-EXCISION-BENIGN-LESION-TRUNK-ARMS-LEGS-1-1-TO-2-0-CM

    CPT 11402: Excision of Benign Skin Lesion, 1.1–2.0 cm

    CPT-11404-EXCISION-BENIGN-LESION-TRUNK-ARMS-LEGS-3-1-4-0-CM

    CPT 11404: Excision of Benign Lesion 3.1–4.0 cm, Trunk/Arms/Legs

    CPT-11406-EXCISION-BENIGN-SKIN-LESION-TRUNK-ARMS-LEGS-GREATER-THAN-4CM

    CPT 11406: Excision of Benign Lesion >4.0 cm, Trunk/Arms/Legs

    CPT-11420-EXCISION-BENIGN-LESION-05CM-OR-LESS-SCALP-NECK-HANDS-FEET-GENITALS

    CPT 11420: Excision of Noncancerous Skin Lesion, ≤0.5 cm

    CPT-11421-BENIGN-SKIN-LESION-EXCISION-0-6-TO-1-0-CM

    CPT 11421: Excision of Benign Skin Lesion 0.6–1.0 cm

    CPT-11422-EXCISION-BENIGN-SKIN-LESION-1-1-TO-2-0-CM

    CPT 11422: Excision, Benign Skin Lesion 1.1–2.0 cm

    CPT-11423-EXCISION-BENIGN-SKIN-LESION-2-1-TO-3-0-CM-SCALP-NECK-HANDS-FEET-GENITALS

    CPT 11423: Excision of Benign Skin Lesion 2.1–3.0 cm

    CPT-11424-EXCISION-BENIGN-SKIN-LESION-3-1-4-0-CM

    CPT 11424: Excision of Benign Skin Lesion 3.1–4.0 cm

    Showing 1–10 of 23

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Lower-weight sibling code used when the excised lesion measures ≤ 0.5 cm; choose based on measured excised diameter.
    11402Excision, benign lesion including margins, except skin tag, trunk, arms or legs; excised diameter 1.1 to 2.0 cmAdjacent-size code used when excised diameter is 1.1–2.0 cm; select the code matching the actual excised diameter.
    11443Excision, other benign lesion including margins, except skin tag, face, ears, eyelids, nose, lips, mucous membrane; excised diameter > ? cmRelated face/head/neck code category; not used for trunk/arms/legs but relevant when lesion located on face or mucous membranes requiring different code selection.