Summary & Overview
CPT 11426: Excision of Large Benign Skin Lesion (>4.0 cm)
CPT code 11426 designates the surgical excision of a noncancerous skin lesion (excluding skin tags) larger than 4.0 cm in diameter, including required margins, when located on the scalp, neck, hands, feet, or genitals. As a distinct operative code for large benign cutaneous lesions in anatomically sensitive locations, it carries implications for surgical scheduling, site-of-service selection, and payer coverage determination nationally. This code matters because it differentiates larger excisions from smaller lesion removals and from oncologic excisions, affecting reimbursement pathways and documentation expectations.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for excision of large benign lesions, typical sites of service, and common billing considerations tied to CPT code 11426.
The publication provides benchmarks where available, summarizes recent policy updates that affect code use and documentation, and outlines the clinical scenarios that typically map to this code. It also explains common service-line implications for dermatology and general surgery practices, and highlights areas where additional clinical detail or operative documentation is frequently required. Data not available in the input: specific payer fee schedules, associated taxonomies, and ICD-10 diagnosis pairings.
Billing Code Overview
CPT code 11426 describes the surgical excision of a noncancerous skin lesion (excluding skin tags) greater than 4.0 cm in diameter, including margins. The procedure involves complete removal of the lesion with appropriate peripheral and deep margins as required for the specified anatomy.
Service type: Surgical excision of benign skin lesion
Typical site of service: Scalp, neck, hands, feet, or genitals
Data not available in the input for associated taxonomies, specific ICD-10 diagnoses, and related procedure codes.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient presents to the dermatology clinic with a slowly enlarging, benign-appearing cutaneous lesion on the dorsal scalp measuring approximately 4.5 cm in greatest diameter. The lesion has been symptomatic with occasional bleeding and local irritation from contact with clothing. After clinical evaluation and review of prior biopsy results confirming a noncancerous lesion (for example, a large epidermal inclusion cyst or benign lipoma of the scalp), the provider plans an excision with appropriate margins. The procedure is scheduled in an ambulatory surgery center. Preoperative steps include informed consent, marking the surgical margins, local anesthesia with or without monitored anesthesia care, and standard sterile preparation. The surgeon performs an elliptical excision of the lesion including margins, closes the defect with layered suturing and skin closure, and sends tissue to pathology if indicated. Postoperative care includes wound care instructions, pain management, and a follow-up visit for suture removal and wound assessment. Typical documentation includes lesion size (greater than 4.0 cm), anatomic site (scalp), benign pathology or clinical diagnosis, details of technique, anesthesia, estimated blood loss, and any complications.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation or surgical component when facility (technical) services billed separately. |
50 | Bilateral procedure | Use when identical lesion excisions are performed on bilateral anatomic sites during the same operative session. |
51 | Multiple procedures | Use when multiple distinct procedures are performed during the same operative session and payer requires the multiple procedure indicator. |
52 | Reduced services | Use when the excision is intentionally partially reduced or not completed as typically described. |
53 | Discontinued procedure | Use when the excision is started but halted due to extenuating circumstances not related to patient improvement. |
59 | Distinct procedural service | Use to indicate a separate and distinct procedure when another service might be bundled; e.g., a separate unrelated excision on a different anatomic site. |
62 | Two surgeons | Use when two surgeons work together as primary surgeons performing distinct portions of the excision/closure. |
66 | Surgical team | Use when a surgical team approach is reported for complex reconstruction or prolonged procedures requiring multiple specialists. |
76 | Repeat procedure by same physician | Use when the same physician repeats the excision or returns to the operating room for the same procedure within the global period. |
77 | Repeat procedure by another physician | Use when a different physician repeats the procedure 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 that is not related to the original excision. |
22 | Increased procedural services | Use when work required to perform the excision is substantially greater than typically required (document rationale). |
52 | Reduced services | Use when the service provided is less than described by the full code due to medical reasons (duplicate listed intentionally above for emphasis on common use). |
LT | Left side | Use to designate the left anatomic side when laterality is required. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207P00000X | Dermatology | Dermatologists commonly perform large skin lesion excisions on the scalp, neck, hands, feet, and genital areas. |
| 207L00000X | Plastic Surgery | Plastic and reconstructive surgeons perform excisions and complex closures, particularly when reconstruction is needed. |
| 208000000X | General Surgery | General surgeons may perform excisions in settings such as ambulatory surgery centers when lesions are large or require deeper dissection. |
| 207X00000X | Otolaryngology | Otolaryngologists often manage scalp and neck lesions requiring excision, especially near hairlines or neck structures. |
| 208100000X | Surgical Oncology | Surgical oncologists may be involved when lesion characteristics raise concern or when coordination with pathology is necessary. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
L72.0 | Acne cysts and nodules | Large cystic lesions such as epidermal inclusion cysts on the scalp may be coded here when benign cysts are excised. |
D23.0 | Benign neoplasm of skin of the lip | Example benign skin neoplasm code; benign cutaneous neoplasms in anatomically similar categories guide excision coding. |
D23.9 | Benign neoplasm of skin, unspecified | Used when a benign skin neoplasm is the diagnosis but a more specific code is not documented; applicable to large benign lesions. |
L75.9 | Disorder of hair follicle, unspecified | Certain follicular-origin lesions on the scalp that require excision may be described under this code. |
L98.9 | Disorder of skin and subcutaneous tissue, unspecified | Used when the lesion is nonmalignant but lacks a specific documented benign diagnosis. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
11646 | Excision, benign lesion including margins, scalp, neck, hands, feet, or genitalia; excised diameter 2.1 cm to 3.0 cm | Performed for smaller benign lesions; used for sizing and coding comparison when lesion diameter is less than thresholds for 11426. |
11422 | Excision, benign lesion including margins, scalp, neck, hands, feet, or genitalia; excised diameter 2.1 cm to 3.0 cm (site-specific earlier series code) | Alternative size-based code in the series used when lesion dimensions fall into different size brackets during clinical workflow. |
12032 | Repair, intermediate, wounds of scalp, arms, and/or legs; 2.6 cm to 7.5 cm | Used for layered closure techniques after excision when the soft-tissue repair meets intermediate repair complexity; may be billed when closure complexity warrants separate coding. |
11100 | Biopsy of skin, single lesion | Performed when an initial diagnostic biopsy is taken prior to definitive excision to confirm benign pathology. |
88305 | Level IV surgical pathology, gross and microscopic examination | Used when the excised tissue is submitted to pathology for evaluation following the excision procedure. |