Summary & Overview

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

CPT code 11423 denotes the surgical excision of a benign (noncancerous) skin lesion, excluding skin tags, when the lesion measures 2.1 to 3.0 cm in diameter including margins and is located on the scalp, neck, hands, feet, or genitals. This code is used to classify a common outpatient dermatologic procedure with implications for surgical coding accuracy, payer coverage determinations, and clinical documentation standards. Accurate use of this code affects claims processing, utilization tracking, and quality reporting across national payers.

Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The discussion addresses payer coverage considerations and typical billing contexts for outpatient excisions of benign lesions, highlighting where documentation must support lesion size and anatomical site.

Readers will find concise benchmarks for coding practice, an overview of the clinical context for the procedure, and notes on common billing considerations such as service setting and lesion characteristics. Data not available in the input is explicitly noted where applicable. The content is intended for national audiences involved in clinical documentation, coding, revenue cycle management, and policy oversight.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare11423CPTskin excisiondermatologic surgeryoutpatient surgerybenign skin lesionprocedure codingsurgical dermatology

Billing Code Overview

CPT code 11423 describes the excision of a noncancerous skin lesion (excluding a skin tag) measuring 2.1 to 3.0 cm in diameter, including margins, when removed from the scalp, neck, hands, feet, or genitals. This procedure is a straightforward surgical excision of a benign cutaneous lesion and typically involves local excision with appropriate margins for complete removal.

Service Type: Excision of benign skin lesion (simple surgical procedure)

Typical Site of Service: Outpatient surgical setting or office-based procedure room, with the lesion located on the scalp, neck, hands, feet, or genital area.

Clinical & Coding Specifications

Clinical Context

A 54-year-old patient presents to a dermatology clinic with a slowly enlarging, noncancerous (benign) cutaneous lesion on the dorsal hand that measures approximately 2.5 cm in greatest diameter including margins. The lesion is symptomatic with intermittent tenderness and has cosmetic concern. After clinical evaluation and discussion of risks and benefits, the dermatologist schedules an outpatient excision. On the day of service, the patient is prepared in a procedure room; local anesthesia (lidocaine with epinephrine) is administered, standard sterile technique is used, and the provider excises the lesion with a 2.5 cm total diameter specimen including margins. Hemostasis is achieved with cautery, a layered closure is performed, and dressings applied. Tissue is submitted to pathology if indicated. The service is billed using 11423 for excision of a benign lesion, 2.1–3.0 cm, from a site included in the code description (hand). Typical site of service is an outpatient dermatology office or ambulatory surgical center. Common clinical workflow steps include pre-procedure evaluation and consent, local anesthesia administration, lesion excision with margin, wound closure, immediate post-procedure instructions, and pathology processing if submitted. Documentation should include lesion location, size (including margins), procedure details, anesthesia, closure technique, and follow-up plan.

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 distinct E/M visit is performed and separately documented on the same day as `11423`.
`50`	Bilateral procedure	Use if identical lesion excisions meeting descriptor are performed bilaterally in paired sites and payer allows bilateral reporting.
`51`	Multiple procedures	Use when `11423` is billed with additional distinct procedures on the same date; some payers expect reduced payment for secondary procedures.
`52`	Reduced services	Use when the excision is partially reduced or abandoned — document the reason and extent of reduction.
`53`	Discontinued procedure	Use if the excision was started but discontinued due to extenuating circumstances; document reason for discontinuation.
`59`	Distinct procedural service	Use to indicate a separate, independent procedure not normally billed together with `11423` when performed same day (e.g., separate lesion at a distant site).
`76`	Repeat procedure by same physician	Use when the same procedure is repeated by the same provider within the global period.
`77`	Repeat procedure by a different physician	Use when the procedure is repeated by a different provider within 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 for a condition unrelated to the original excision.
`22`	Increased procedural services	Use when work or complexity substantially exceeds that typically required; documentation must support increased work.
`52`	Reduced services	Use when services are partially reduced or abandoned — document extent and reason.
`26`	Professional component	Use if billing only the professional component when the technical component is billed separately by another entity (rare for simple excision).
`RT`	Right side	Use to identify the right side when laterality is required by payer.
`LT`	Left side	Use to identify the left side when laterality is required by payer.

Taxonomy Code	Specialty	Notes
`207N00000X`	Dermatology	Most common specialty performing skin lesion excisions.
`207P00000X`	Dermatopathology	Involved when pathology processing and microscopic diagnosis are provided.
`208100000X`	Plastic Surgery	Performs excisions requiring complex reconstruction or large closures.
`2080P0200X`	General Surgery	May perform excisions in noncutaneous or complex locations.
`363L00000X`	Family Medicine	Performs outpatient skin excisions in office settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`L98.0`	Pyogenic granuloma	Benign vascular lesion that may require excision for bleeding or irritation.
`L91.0`	Hypertrophic scar	Symptomatic or cosmetically concerning scars on hands or feet that may be excised.
`D22.9`	Melanocytic nevus, unspecified	Common benign pigmented lesion that may be excised when enlargement or symptoms occur.
`L57.9`	Actinic keratosis, unspecified (benign precancerous lesion)	May be treated by excision if atypical or refractory to other therapies.
`L82.0`	Seborrheic keratosis	Common benign epidermal lesion frequently removed for symptoms or cosmesis.
`L60.0`	Ingrowing nail	When nail-related lesions on digits require excision of adjacent tissue (site-specific applicability).
`S91.311A`	Laceration without foreign body of right toe, initial encounter	Traumatic lesions or retained scar tissue on hands/feet sometimes require excision during repair.
`L50.9`	Urticaria, unspecified	Included only when chronic localized urticarial lesions are excised for diagnosis or symptom control.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11423`	Excision, benign lesion including margins; 2.1 cm to 3.0 cm (scalp, neck, hands, feet, genitalia)	Primary procedure for excision of a benign lesion in this size range at specified anatomic sites.
`12032`	Repair, intermediate, wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities; 2.6 cm to 7.5 cm	May be reported when intermediate layered repair is performed following excision; choose appropriate closure code matching repair type and size.
`11100`	Biopsy of single lesion, shave; single lesion	Performed when an initial diagnostic shave biopsy is done prior to definitive excision.
`11101`	Biopsy of each additional lesion, shave	Use when multiple shave biopsies are performed at same encounter before or in addition to excision.
`88305`	Surgical pathology, gross and microscopic examination, intermediate complexity	Reported when submitted tissue from the excision is processed and examined by pathology; choose appropriate level based on specimen complexity.
`13132`	Repair, complex, forehead, cheeks, chin, mouth, eyelids, nose, ears; 2.6 cm to 7.5 cm	Use when complex repair or flap/graft is required after excision at applicable anatomic sites.