Summary & Overview
CPT 11623: Excision of Malignant Skin Lesion, 2.1–3.0 cm
CPT code 11623 represents the surgical excision of a malignant skin lesion, including margins, for lesions measuring 2.1 to 3.0 cm in diameter on anatomically sensitive sites such as the scalp, neck, hands, feet, or genitalia. This code defines a specific operative service that influences surgical planning, coding accuracy, and national billing patterns for skin cancer treatment.
Key payers in scope include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage policies and prior authorization practices among these payers affect site-of-service decisions and documentation requirements for malignant lesion excisions.
Readers will find a concise overview of clinical context and service definition, payer coverage scope, common modifiers associated with the service, and related billing considerations. The publication highlights benchmarks for coding specificity, documentation needed to support lesion size and anatomic site, and common areas of billing denials or audit focus. It also summarizes implications for surgical workflow and claims submission to help clinical and revenue cycle teams align documentation with payer expectations.
Data not available in the input for specific payer rates, regional variations, or ICD-10 mappings; those elements are not included here.
Billing Code Overview
CPT code 11623 describes the excision of a malignant skin lesion, including margins, with a lesion diameter of 2.1 to 3.0 cm. The procedure is a surgical skin excision for malignant (cancerous) lesions.
Service Type: Surgical excision of malignant skin lesion
Typical Site of Service: Scalp, neck, hands, feet, or genitalia (sex organs)
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 68-year-old male presents to the dermatologic surgery clinic with a biopsy-proven cutaneous squamous cell carcinoma on the dorsal aspect of the right hand measuring approximately 2.4 cm in greatest diameter. The evaluation includes lesion mapping, review of prior biopsy pathology, and discussion of risks, benefits, and expected margins. On the day of service the patient is prepped in a minor procedure suite; local anesthesia is administered and the surgeon excises the malignant lesion with appropriate margins. Hemostasis is obtained, and the defect is closed by primary repair. Specimen orientation and labeling are performed and the specimen is sent to pathology for margin assessment. Post-procedure documentation includes lesion size, margin size, exact anatomic location (right dorsal hand), anesthesia type, wound closure technique, and specimens submitted. Typical site of service is an outpatient dermatology or surgical clinic procedure room or ambulatory surgery center. The service performed aligns with excision of a malignant lesion with diameter between 2.1 and 3.0 cm from skin of the hands, consistent with 11623.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the physician’s professional component separate from technical services (rare for excisions). |
50 | Bilateral procedure | Use when the same excision is performed on both right and left anatomic structures in the same session. |
51 | Multiple procedures | Use when multiple distinct procedures are performed during the same encounter in addition to the excision. |
52 | Reduced services | Use when the excision is partially reduced or not completed as originally planned. |
53 | Discontinued procedure | Use when the procedure is started but terminated for patient-related or other emergent reasons. |
59 | Distinct procedural service | Use to indicate a separate and distinct procedure not normally reported together, when appropriate. |
62 | Two surgeons | Use when two surgeons work together as primary surgeons performing distinct portions of the excision/repair. |
76 | Repeat procedure by same physician | Use when the same physician repeats the procedure later the same day. |
77 | Repeat procedure by another physician | Use when another physician repeats the procedure later the same day. |
79 | Unrelated procedure/service by same physician during postoperative period | Use when an unrelated excision is performed during the global period of a prior procedure. |
RT | Right side | Use to identify procedures performed on the right side (e.g., right hand). |
LT | Left side | Use to identify procedures performed on the left side. |
GA | Waiver of liability statement on file (Note: not in provided list) | Data not available in the input. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207Q00000X | Dermatology | Dermatologic surgeons commonly perform skin cancer excisions. |
| 2080P0207X | General Surgery | General surgeons perform skin and soft tissue excisions, especially on hands/feet when complex. |
| 2084P0800X | Plastic Surgery | Plastic surgeons perform excisions with complex closure or reconstruction. |
| 207RI0001X | Mohs Micrographic Surgery (Dermatologic) | Relevant when margin-controlled excision techniques are used; may be involved in care coordination. |
| 103K00000X | Podiatry | Podiatrists perform excisions on foot lesions when applicable. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
C44.112 | Squamous cell carcinoma of skin of right upper limb, including shoulder | Common malignant diagnosis for skin on the hand requiring excision. |
C44.113 | Squamous cell carcinoma of skin of left upper limb, including shoulder | Relevant for left-sided hand lesions. |
C44.212 | Squamous cell carcinoma of skin of right lower limb, including hip | Relevant when similar lesions occur on the foot. |
C44.91 | Unspecified malignant neoplasm of skin, site unspecified | Used when documentation does not specify anatomic site but malignancy is present. |
D04.9 | Carcinoma in situ of skin, unspecified | Used when lesion represents in situ disease that may still be excised, though 11623 is for malignant invasive lesions. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
11102 | Tangential biopsy of skin (shave), single lesion | Performed before excision when an initial diagnostic shave biopsy established malignancy. |
11107 | Tangential biopsy of skin (shave), each additional lesion | Additional shave biopsies when multiple suspicious lesions are sampled prior to definitive excision. |
11423 | Excision, malignant lesion diameter 1.1 to 2.0 cm, scalp/neck/hand/foot/genitalia | Used when lesion size is smaller; represents a lower-level excision code in the same family as 11623. |
11626 | Excision, malignant lesion diameter 3.1 to 4.0 cm, scalp/neck/hand/foot/genitalia | Used when lesion is larger and would be reported instead of 11623. |
12032 | Repair, intermediate, wounds of face/eyelids/nose/lips/skin; 2.6 cm to 7.5 cm | Commonly used for intermediate layered closure when closure type and site match; reported in addition to excision when appropriate. |
88305 | Level IV surgical pathology, gross and microscopic examination | Used when the excised malignant specimen is submitted to pathology for definitive diagnosis and margin assessment. |