Summary & Overview
CPT 11601: Excision of Malignant Skin Lesion, 0.5 cm or Less
CPT code 11601 represents the surgical excision of a malignant skin lesion, including margins, on the trunk, arms, or legs, with a diameter of 0.5 cm or less. This code is significant in dermatology and surgical practice, as it addresses the removal of early-stage skin cancers and ensures appropriate clinical documentation for reimbursement. The procedure is commonly performed in both hospital and office settings, reflecting its versatility in patient care.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, recognize and reimburse for CPT code 11601, making it a widely accepted standard for reporting small malignant skin lesion excisions. Readers will gain insight into payer coverage, clinical benchmarks, and policy updates relevant to this code. The publication also provides context on associated modifiers, relevant provider taxonomies, and ICD-10 diagnoses linked to melanoma in situ and other malignant skin conditions. Additionally, related CPT codes for excision of larger or differently located lesions are outlined, offering a comprehensive view of coding options for malignant skin excisions.
This summary equips healthcare professionals, billing specialists, and policy analysts with the essential information needed to understand the clinical and administrative significance of CPT code 11601 in the broader landscape of skin cancer management and medical billing.
CPT Code Overview
CPT code 11601 is used to report the excision of a malignant skin lesion, including margins, on the trunk, arms, or legs, where the diameter of the lesion is 0.5 cm or less. This procedure is classified as a surgical intervention within the integumentary system and is performed to remove cancerous tissue, ensuring clear margins to reduce the risk of recurrence. The service may be provided in both facility settings, such as hospitals, and non-facility settings, including physician offices, depending on clinical circumstances and patient needs.
Clinical & Coding Specifications
Clinical Context
A patient presents to a dermatology clinic with a suspicious skin lesion on the trunk, arm, or leg. The lesion is clinically diagnosed as malignant, such as melanoma in situ, and measures 0.5 cm or less in diameter. After evaluation, the provider determines that excision is necessary to remove the lesion, including appropriate margins to ensure complete removal. The procedure is performed in either an office or hospital setting, depending on patient needs and provider practice. The excised tissue is sent for pathological analysis to confirm diagnosis and margin status. Documentation includes lesion size, location, and pathology findings.
Coding Specifications
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Modifier
59: Distinct Procedural Service. Used when a procedure or service is distinct or independent from other services performed on the same day, such as excising multiple lesions at different anatomical sites. -
Modifier
51: Multiple Procedures. Used when more than one procedure is performed during the same session, such as excision of multiple lesions.
| Modifier Code | Description |
|---|---|
59 | Distinct Procedural Service |