Summary & Overview
CPT 11406: Excision of Benign Skin Lesion >4.0 cm on Trunk/Arms/Legs
CPT code 11406 denotes the surgical excision of a noncancerous skin lesion (excluding skin tags) larger than 4.0 cm in diameter from the trunk, arms, or legs. This code captures a common dermatologic and surgical procedure with implications for resource use, site-of-service decisions, and payer coverage policies at a national level. Accurate use of the code affects payment, quality measurement, and care setting choices for sizable benign cutaneous lesions.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise national overview of coding intent, clinical context, and the typical sites where the service is delivered. Readers will find benchmarks for utilization and reimbursement structures where available, guidance on documentation elements that support code selection, and summaries of notable policy or coverage considerations relevant to large benign lesion excisions. The content is designed for billing professionals, dermatologists, general surgeons, and health policy analysts who need clear, code-specific context for operational, clinical, and payer discussions.
Data not available in the input for payer-specific rates, associated taxonomies, and ICD-10 linkage is noted where applicable. The piece emphasizes the clinical description and service setting to support correct coding and administrative handling at a national scale.
Billing Code Overview
CPT code 11406 describes the surgical excision of a noncancerous skin lesion (excluding a skin tag) greater than 4.0 cm in diameter, including margins, from the trunk, arms, or legs. This procedure is performed by a qualified provider to remove benign cutaneous lesions that require excision with margins due to size or clinical characteristics.
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Service type: Surgical excision of benign skin lesion
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Typical site of service: Ambulatory surgical center or hospital outpatient department; may also be performed in an office-based procedure room depending on clinical complexity and local regulations
Clinical & Coding Specifications
Clinical Context
A 54-year-old patient presents to an outpatient dermatologic or surgical clinic with a progressively enlarging, benign-appearing soft tissue lesion on the lateral thigh measuring 5.0 cm in greatest diameter. The lesion is clinically consistent with a benign epidermal inclusion cyst or lipoma causing discomfort and impaired mobility from chafing. The provider reviews history and performs an examination, documents size including margins, discusses risks and benefits, obtains informed consent, and schedules an excision. On the day of service the patient undergoes a full-thickness elliptical excision of the lesion under local anesthesia with monitored vital signs in an ambulatory surgical center. Hemostasis is achieved, the specimen is labeled and sent for pathology as requested, and layered closure is performed. Postoperative instructions and wound care are provided; the encounter is documented with lesion size (>4.0 cm), anatomical site (trunk/arm/leg), anesthesia type, closure technique, and whether pathology was submitted.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure | Use when a separate E/M visit is performed and documented in addition to the excision on the same date |
| 51 | Multiple procedures | Use when additional distinct surgical procedures are performed at the same session
| 52 | Reduced services | Use if the excision was partially reduced or discontinued
| 53 | Discontinued procedure | Use if the excision was started but terminated for patient safety reasons
| 59 | Distinct procedural service | Use to indicate a separately identifiable procedure or service not normally reported together
| 62 | Two surgeons | Use when two surgeons work together as primary surgeons performing distinct portions of the procedure
| 66 | Surgical team | Use when services are performed by a surgical team for a complex case
| 76 | Repeat procedure by same physician | Use when the provider repeats the procedure subsequent to the initial attempt on the same day
| 78 | Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period | Use when the patient returns to the OR for a related reason in the global period
| 79 | Unrelated procedure or service by the same physician during the postoperative period | Use when an unrelated procedure is performed during the global period
| LT | Left side | Use to designate the left anatomical site when laterality is reportable
| RT | Right side | Use to designate the right anatomical site when laterality is reportable
| TC | Technical component | Use when billing only the technical component of a service if applicable (e.g., facility charges separated)
| 26 | Professional component | Use when billing only the professional component of a service if applicable
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207Q00000X | Dermatology | Dermatologic surgeons commonly perform skin excisions on trunk, arms, and legs |
| 207P00000X | General Surgery | General surgeons perform excisions of large cutaneous and subcutaneous lesions
| 2080P0004X | Family Medicine | Family physicians with procedural skills may perform excisions in office settings
| 2085R0202X | Plastic Surgery | Plastic surgeons perform excisions when reconstruction or complex closure is anticipated
| 363L00000X | Podiatry | Podiatrists may perform excisions on lower extremity (leg/foot) lesions when within scope
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
L72.0 | Epidermal cyst | Common benign lesion that may require excision when symptomatic or enlarging |
| D17.2 | Benign lipomatous neoplasm of trunk | Lipomas of the trunk frequently exceed 4.0 cm and are treated with excision
| L90.5 | Scar conditions and fibrosis of skin | Symptomatic or hypertrophic scars may be excised for functional or cosmetic reasons
| M79.1 | Myalgia | Pain related to a subcutaneous mass may be coded when pain is the presenting symptom prompting excision
| L98.9 | Disorder of skin and subcutaneous tissue, unspecified | Used when a specific benign skin lesion diagnosis is not established preoperatively
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
12032 | Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities; 2.6 cm to 7.5 cm | Used to report layered intermediate closure when performed after excision when separate suture repair code is appropriate |
| 11042 | Debridement; subcutaneous tissue (includes epidermis and dermis if performed), first 20 sq cm or less | May be performed prior to or in conjunction with excision when extensive debridement of necrotic tissue is required
| 11102 | Tangential biopsy of skin (eg, shave), single lesion | Alternative diagnostic procedure for lesions when full excision is not performed
| 88305 | Surgical pathology, gross and microscopic examination | Used when the excised specimen is submitted for pathological evaluation to establish diagnosis
| 12001 | Repair, simple, wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities; 2.5 cm or less | Smaller repair code used when closure components differ or if sizing requires separate reporting