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CPT 11604: Excision of Malignant Skin Lesion, Trunk/Arms/Legs 3.1–4.0 cm
Headline: CPT code 11604: Excision of malignant skin lesion on trunk, arms, or legs, 3.1–4.0 cm
Lead: CPT code 11604 identifies the surgical removal of a malignant skin lesion, including margins, where the excised diameter measures 3.1 to 4.0 cm on the trunk, arms, or legs. This code is used across outpatient and ambulatory surgical settings and is central to billing for procedural dermatology and surgical oncology services.
What this code represents and why it matters: CPT code 11604 captures a specific tier of oncologic skin excision based on lesion size and location. Accurate coding affects clinical documentation, payer adjudication, and national procedure utilization metrics for dermatologic cancer care. The code aligns clinical procedure detail (malignant lesion excision with margins) with billing classification used by major payers.
Key payers covered: Analysis includes common national payers: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
What readers will learn: The publication provides benchmarks and context for coding and billing of surgical excisions of malignant skin lesions in the 3.1–4.0 cm range, clarifies typical sites of service and service type, and situates 11604 relative to adjacent procedure codes. Readers will find clinical context for use of the code, payer coverage considerations, and links to related procedural codes for sizing and site comparisons.
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Billing Code Overview
CPT code 11604 describes the surgical excision of a malignant skin lesion with margins, where the excised diameter is 3.1 to 4.0 cm. The procedure involves removal of cancerous tissue from the skin of the trunk, arms, or legs and includes excision of surrounding margins as part of oncologic management.
Service type: Surgical excision of malignant skin lesion
Typical site of service: Outpatient surgical setting or ambulatory procedure clinic for dermatologic surgery
National Reimbursement Benchmarks
Medicare’s mean rate of $321.30 sits noticeably below BUCA’s average commercial mean of $766.50, indicating commercial contracts with BUCA pay, on average, roughly $445.20 more per service than Medicare. That spread highlights a meaningful gap between public fee schedules and BUCA’s commercial positioning for CPT 11604.
Dispersion measured as the interquartile range (P75–P25) is widest for Blue Cross Blue Shield at $1,014.60 (P75 $1,455.60 minus P25 $540.10) and notably wide for UnitedHealth Group at $321.10 and BUCA at $632.90. The tightest dispersion is Aetna at $206.00, followed by Cigna at $255.70, indicating more concentrated reimbursement outcomes for those payers relative to Blue Cross Blue Shield and BUCA.