Summary & Overview
CPT 11422: Excision of Benign Skin Lesion 1.1–2.0 cm
CPT code 11422 describes the surgical excision of a benign (noncancerous) skin lesion, excluding skin tags, with a diameter of 1.1 to 2.0 cm including margins. This code is widely used across outpatient dermatology and minor surgical settings for definitive removal of benign cutaneous lesions located on sensitive or cosmetically important areas such as the scalp, neck, hands, feet, and genitals. Nationally, accurate use of this code matters for consistent clinical documentation, billing integrity, and appropriate payment for minor surgical services.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical intent and typical sites of service, plus what to expect in payer coverage patterns and benchmarking context. The publication summarizes common billing practices, allowed services under this code, and the clinical contexts that typically justify use of 11422.
The report provides benchmarks for utilization and reimbursement trends, highlights policy or coding clarifications that affect claim adjudication, and situates 11422 among related procedural codes for lesion excision. Data not available in the input is noted where applicable, and the content is organized to support coding teams, clinicians, and policy analysts who need a clear, national-level reference for CPT code 11422.
Billing Code Overview
CPT code 11422 describes the excision of a noncancerous skin lesion (excluding a skin tag) measuring 1.1 to 2.0 cm in diameter, including margins. The procedure involves surgical removal of the lesion and surrounding tissue to ensure complete excision.
Service Type: Skin lesion excision, minor outpatient surgical procedure
Typical Site of Service: Scalp, neck, hands, feet, or genital skin; most often performed in outpatient dermatology or minor procedure clinics, ambulatory surgery centers, or physician office procedure rooms.
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient presents to a dermatology clinic with a symptomatic, benign-appearing skin lesion on the dorsal hand measuring approximately 1.5 cm in greatest diameter. The lesion has been present for months, is intermittently painful with minor trauma, and the patient requests removal for comfort and cosmesis. The provider performs a focused history and skin exam, documents informed consent, photographs the lesion, and marks surgical margins. Local anesthesia is administered. The provider excises the lesion including margins using elliptical technique, achieves hemostasis, and closes the wound with layered suturing. The specimen is sent for routine pathology if indicated. Post-procedure the provider gives wound care instructions, schedules suture removal in 7–14 days, and documents the procedure, estimated size including margins (1.1–2.0 cm), anatomic site (hand), and any immediate complications.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the day of a procedure | When a distinct E/M visit is documented on the same day as the excision (e.g., pre-procedure evaluation beyond typical pre-op counseling) |
52 | Reduced services | When the excision is partially reduced or not completed as described (e.g., abortive procedure) |
53 | Discontinued procedure | When procedure is started but terminated due to unforeseen circumstance (e.g., anesthesia issue) |
59 | Distinct procedural service | When a separate, unrelated procedure is performed at a different anatomic site on the same day (use with supporting documentation) |
51 | Multiple procedures | When multiple procedures are performed during the same session and payer requires indication of multiple procedural billing |
50 | Bilateral procedure | If identical excisions are performed on both hands or other bilateral sites (use if payer accepts) |
76 | Repeat procedure or service by same physician | When the same procedure is repeated later the same day by the same provider |
77 | Repeat procedure by another physician | When the same procedure is repeated later the same day by a different physician |
22 | Increased procedural services | When work required is substantially greater than typical for this CPT (must document rationale) |
79 | Unrelated procedure or service by the same physician during the postoperative period | When an unrelated excision is performed during global period; separate billing may be indicated |
26 | Professional component | If only the professional component is billed (rare for minor surgical excisions done in-office) |
TC | Technical component | If only the technical component is billed (e.g., facility bills technical; rarely applicable in office-based excision) |
GA | Waiver of liability statement on file, no ABN required | When patient has signed a voluntary underpayment acknowledgment applicable per payer policy |
GZ | Item or service expected to be denied as not reasonable and necessary | When provider documents medically unnecessary per Medicare expectations (use with caution and documentation) |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207Q00000X | Dermatology | Dermatologists commonly perform skin lesion excisions in office settings |
| 207L00000X | General Practice | Primary care physicians may perform minor skin excisions in office or ambulatory settings |
| 207R00000X | Family Medicine | Family medicine clinicians often perform minor dermatologic procedures including excisions |
| 208D00000X | Plastic Surgery | Plastic surgeons perform excisions when reconstruction or complex closure is anticipated |
| 2080P0006X | Otolaryngology (ENT) | ENT may perform excisions on scalp or neck lesions requiring specialty approach |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
| Data not available in the input. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
11400 | Excision, benign lesion including margins; 0.5 cm or less | Smaller-size counterpart; used when lesion measures ≤0.5 cm and helps select appropriate size-based code in the same family |
11401 | Excision, benign lesion including margins; 0.6 to 1.0 cm | Used when lesion size falls into 0.6–1.0 cm range instead of 11422 |
11423 | Excision, benign lesion including margins; 2.1 to 3.0 cm (scalp, neck, hands, feet, genitalia) | Next size-up code used when measured lesion including margins exceeds 2.0 cm |
12031 | Repair, intermediate, face, ears, eyelids, nose, lips; 2.6 cm to 7.5 cm | Represents layered intermediate closure codes that may be reported when complex closure beyond simple layered suturing is performed after excision (select per payer rules) |
17000 | Destruction, premalignant lesion (e.g., actinic keratoses); first lesion | Alternate treatment modality; may be performed on same patient for other lesions in workflow |
11100 | Biopsy of single lesion, tangential (shave), trunk, arms or legs; single lesion | Performed when diagnostic sampling is chosen instead of or prior to complete excision; guides management decisions |