CPT 11446: Excision of Benign Facial Lesion >4.0 cm with Simple Closure - OpenPayer

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Summary & Overview

CPT 11446: Excision of Benign Facial Lesion >4.0 cm with Simple Closure

CPT code 11446 denotes the surgical excision of a benign lesion larger than 4.0 cm located on the face, ears, eyelids, nose, lips, or mucous membrane, with a simple (nonlayered) closure. This code is important nationally because it defines a distinct procedural category for sizable benign cutaneous and mucosal lesions in cosmetically sensitive and functionally critical facial regions, which affects coding, billing, and clinical documentation. Coverage and reimbursement practices for this procedure influence access to specialized surgical and dermatologic care and can vary by payer. Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will find a concise overview of the clinical and coding definition of the service, comparisons of payer coverage patterns and common billing practices, and operational considerations for claims submission. The publication outlines typical sites of service, common modifier usage (listed separately), and areas where documentation drives appropriate code selection. It also highlights benchmarking and policy update topics relevant to surgical excisions of benign facial lesions, with the aim of clarifying coding boundaries and administrative expectations for providers and billing professionals.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare11446CPTskin-excisiondermatologic-surgeryfacial-lesionoutpatient-surgerysimple-closureprocedure-coding

Billing Code Overview

CPT code 11446 describes the excision of a benign (noncancerous) lesion from the face, ears, eyelids, nose, lips, or mucous membrane when the lesion is over 4.0 cm in diameter and the provider performs a simple (nonlayered) closure.

Service type: Surgical lesion excision with simple closure.

Typical site of service: Outpatient surgical settings, including ambulatory surgery centers, dermatology or otolaryngology procedure suites, and hospital outpatient departments.

Clinical & Coding Specifications

Clinical Context

A 62-year-old patient presents to a dermatology clinic with a large, longstanding benign-appearing epidermal inclusion cyst on the left cheek measuring 4.5 cm in greatest diameter. After clinical evaluation and discussion of risks, benefits, and alternatives, the dermatologist schedules an excision under local anesthesia. The provider performs a full-thickness excision of the lesion with margins appropriate for a benign lesion and completes a simple (nonlayered) primary closure of the wound. Typical documentation in the clinical workflow includes preoperative consent, lesion size and location, description of margin taken, anesthesia type, intraoperative findings, specimen labeling and disposition, and postoperative wound care instructions.

Typical Site of Service

Ambulatory surgical center
Outpatient dermatology clinic procedure room
Hospital outpatient department

Typical Patient Scenario

Adult patient with a benign-appearing skin lesion on the face (ear, eyelid, nose, lip, or mucous membrane) greater than 4.0 cm in diameter
Procedure performed under local anesthesia with simple (nonlayered) closure documented
Specimen sent for pathology if excised tissue requires histologic confirmation

Payor considerations

Common payors for authorization and claims submission include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	When only the physician/professional component is billed separate from technical services (rare for this procedure)
`50`	Bilateral procedure	When identical lesions on both sides of the face are excised during the same operative session
`51`	Multiple procedures	When other unrelated procedures are reported on the same date of service in addition to the excision
`52`	Reduced services	When the excision is partially reduced or not completed as originally planned
`53`	Discontinued procedure	When the procedure is started but terminated due to extenuating circumstances
`59`	Distinct procedural service	When a separate incision/excision at a distinct anatomic site during the same session is reported
`62`	Two surgeons	When two surgeons of different specialties work together as primary surgeons
`66`	Surgical team	When a surgical team performs the procedure (team approach)
`73`	Discontinued outpatient hospital/ASC procedure prior to anesthesia	When an outpatient/ASC procedure is discontinued before anesthesia is administered
`78`	Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period	For return to the OR for a related complication or revision within the global period
`79`	Unrelated procedure or service by the same physician during the postoperative period	For an unrelated procedure during the global period
`LT`	Left side	To identify left-sided procedures when laterality is required by payors
`RT`	Right side	To identify right-sided procedures when laterality is required by payors

Taxonomy Code	Specialty	Notes
`207Q00000X`	Dermatology	Primary specialty performing skin lesion excisions on the face and mucous membranes
`208100000X`	General Surgery	Performs skin and soft tissue excisions when lesions are large or require complex management
`207L00000X`	Otolaryngology (ENT)	Often manages lesions on the nose, lip, or perioral regions and mucous membranes
`2080P0006X`	Plastic Surgery	Consulted for facial lesions where cosmetic closure or reconstruction may be considered
`363LF0000X`	Oral and Maxillofacial Surgery	Performs excisions involving mucous membranes of the oral cavity and complex facial defects

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`L72.0`	Epidermal cyst	Common benign lesion that may require excision when large or symptomatic; fits the clinical indication for `11446`
`L98.0`	Pyogenic granuloma	Benign vascular lesion that can occur on the face or mucous membranes and may require excision with margins
`D23.9`	Benign neoplasm of skin, unspecified	General code for benign skin neoplasms when specific histology is not documented prior to excision
`K13.2`	Granular cell lesion of tongue and oral mucosa	Represents benign mucous membrane lesions of the oral cavity that may require excision larger than 4.0 cm
`Q82.5`	Nevus, congenital	Large congenital nevi on the face or mucous membranes that may require excision for cosmetic or symptomatic reasons

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	Smaller-size benign lesion excisions; used when lesion size and site differ from `11446`
`11420`	Excision, benign lesion including margins; scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm	Representative of excisions of intermediate-sized benign lesions at other anatomic sites; size-based code grouping similar to `11446`
`12021`	Repair, intermediate, wounds of face, ears, eyelids, nose, lips; 2.6 cm to 7.5 cm	Used when layered intermediate closure is performed rather than a simple closure; alternative to the closure component of `11446` if a layered repair is done
`14060`	Adjacent tissue transfer or rearrangement (e.g., flap), forehead, cheeks, chin, mouth, neck; defect 30.1 sq cm to 60.0 sq cm	Performed when primary closure is not possible and local flap reconstruction is needed following excision
`11102`	Tangential biopsy of skin lesion (shave, scoop, saucerize); single lesion	Performed when initial diagnostic shave biopsy is done prior to definitive excision; often part of the diagnostic workflow