Summary & Overview
CPT 11443: Excision of Benign Lesion on Face/Nose/Lips 2.1–3.0 cm
CPT code 11443 represents the surgical excision of a benign skin lesion on cosmetically sensitive areas (face, ears, eyelids, nose, lips, or mucous membrane) that measures 2.1 to 3.0 cm in diameter and includes a simple, nonlayered closure. This code is widely used in dermatology and outpatient surgical settings where precise lesion removal and primary closure are performed. Nationally, accurate coding for procedures on the head and neck is important for appropriate billing, quality measurement, and tracking of surgical workload in ambulatory care.
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 context for 11443, typical sites of service, commonly reported modifiers, and the range of payers that commonly adjudicate these claims. The publication also outlines benchmarking and policy considerations relevant to billing and coverage determinations for excisions on cosmetically sensitive areas, and summarizes where data is not available in the input.
This summary equips revenue cycle managers, clinicians, and policy analysts with a clear understanding of what procedure 11443 captures, why correct assignment matters, and what to expect when preparing claims for national payers.
Billing Code Overview
CPT code 11443 describes the excision of a benign (noncancerous) lesion from the face, ears, eyelids, nose, lips, or mucous membrane measuring 2.1 to 3.0 cm in diameter and includes a simple (nonlayered) closure.
Service type: Surgical excision of benign skin lesion with simple closure.
Typical site of service: Outpatient surgical clinic, dermatology office, ambulatory surgery center, or hospital outpatient department.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient presents to a dermatology clinic with a longstanding, benign-appearing lesion on the left cheek, measuring about 2.5 cm in greatest diameter. After clinical evaluation and dermatoscopic assessment, the dermatologist determines excision is appropriate for definitive removal and cosmesis. The patient is scheduled for a minor outpatient procedure in an ambulatory surgical center. The provider obtains informed consent, marks the lesion and surgical margins, performs local anesthesia (e.g., lidocaine with epinephrine), excises the lesion with appropriate margins, and performs a simple (linear, non-layered) closure of the skin. Specimen is labeled and sent to pathology when indicated. Typical documentation includes lesion size, location (face), benign indication (e.g., intradermal nevus), anesthesia used, type of closure (simple), and any complications.
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 is performed and documented in addition to the excision procedure (not in provided modifier list; not used if not in input) |
26 | Professional component | Use when only the physician work portion is billed separate from technical component (rare for excision) |
50 | Bilateral procedure | Use when the same lesion excision and closure are performed bilaterally in a single session on anatomically paired sites (e.g., both ears) |
51 | Multiple procedures | Use when additional distinct procedures are performed on the same day and payer requires reporting of multiple procedures |
52 | Reduced services | Use when the service performed is partially reduced or not completed as described by the CPT code |
53 | Discontinued procedure | Use when the procedure is terminated due to extenuating circumstances or those that threaten the well-being of the patient |
59 | Distinct procedural service | Use to indicate a separate, distinct procedure or service not normally billed together when appropriate per payer rules |
76 | Repeat procedure by same physician | Use when the identical procedure is repeated later the same day by the same physician |
78 | Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period | Use for an unplanned return to address a complication related to the excision (e.g., bleeding control) |
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 report procedures on the left side when side-specific reporting is required |
RT | Right side | Use to report procedures on the right side when side-specific reporting is required |
TC | Technical component | Use when billing only the technical component (facility or equipment) separate from the professional component |
AS | Physician servicing, patient under anesthesia of another physician | Use when the surgeon provides the procedure while anesthesia is provided by another clinician |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207N00000X | Dermatology | Most common specialty performing skin lesion excisions on the face and neck |
208000000X | Family Medicine | Performs outpatient excisions in clinic for benign skin lesions when within scope of practice |
207P00000X | Otolaryngology (ENT) | Performs excisions on complex facial locations (nose, ears, eyelids, mucous membranes) |
207H00000X | Plastic Surgery | Performs excisions when reconstruction or complex closure/cosmetic considerations are anticipated |
2084P0800X | General Practice | May perform routine skin excisions in ambulatory settings |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
D22.9 | Melanocytic nevus, unspecified | Common benign pigmented lesion that may be excised for diagnosis or cosmesis on the face |
L98.9 | Disorder of skin and subcutaneous tissue, unspecified | General code sometimes used when more specific benign lesion code is not documented (use with caution) |
L92.0 | Granuloma faciale | Benign inflammatory lesion on the face that can require excision for symptomatic or cosmetic reasons |
L91.8 | Other hypertrophic disorders of skin | Includes hypertrophic or benign proliferative lesions that may be excised |
L80 | Vitiligo | May be relevant when tissue removal is undertaken for diagnostic clarification of depigmented lesions (less common) |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
11400 | Excision, benign lesion including margins, trunk, arms or legs; excised diameter 0.5 cm or less | Alternative code for smaller benign lesions on non-facial sites; used when lesion size and site differ from 11443 |
11422 | Excision, benign lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm | Used for benign lesion excision of similar size on non-facial sites where 11443 is not applicable due to site |
12011 | Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities; 2.6 cm to 7.5 cm | Used when layered or intermediate closure is required after excision rather than a simple closure described by 11443 |
12021 | Repair, intermediate, wounds of face, ears, eyelids, nose, lips; 2.6 cm to 7.5 cm | Used when intermediate (layered) repair is performed on the face instead of a simple closure; indicates a different level of closure complexity |
11100 | Biopsy of single lesion, skin; single lesion | Performed when diagnostic biopsy is done prior to or instead of full excision; may occur in the diagnostic workflow |