Summary & Overview
CPT 11626: Excision of Malignant Skin Lesion >4.0 cm
CPT code 11626 denotes the surgical excision of a malignant skin lesion larger than 4.0 cm in diameter, including margins, when located on anatomically challenging areas such as the scalp, neck, hands, feet, or genitalia. Nationally, this code captures a subset of oncologic dermatologic procedures that have implications for surgical planning, resource utilization, and post-operative care due to site-specific complexity and potential reconstruction needs.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, national relevance for coding and billing workflows, and an outline of common modifiers used in practice. The publication highlights benchmarks and coding considerations important for revenue integrity, clinical documentation, and claims processing for large-diameter malignant lesion excisions.
The analysis provides: a clinical description of the service and typical sites of care; a summary of payer coverage patterns and benchmarking context; and a reference list of commonly applied modifiers for this type of surgical excision. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 11626 describes the excision of a malignant skin lesion, including margins, greater than 4.0 cm in diameter. This procedure involves surgical removal of a cancerous lesion from the skin with appropriate margins to achieve oncologic control.
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Service type: Surgical excision of malignant skin lesion
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Typical sites of service: Scalp, neck, hands, feet, or genitalia (sex organs)
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult referred to dermatologic surgery for excision of a biopsy-proven malignant cutaneous neoplasm located on a high-risk site such as the scalp, neck, hands, feet, or genitalia. The lesion measures greater than 4.0 cm in greatest diameter including margins. The preoperative workflow includes history and focused skin exam, review of pathology (e.g., shave or punch biopsy confirming malignancy), informed consent discussing risks of bleeding, infection, scarring, and potential need for reconstruction, and preoperative marking of margins. The procedure is performed in an outpatient minor procedure suite or ambulatory surgery center under local anesthesia with or without sedation depending on patient comorbidity and site. The provider excises the lesion with appropriate oncologic margins; hemostasis is achieved and the resulting defect is managed by primary closure, local flap, or graft as indicated. Specimens are labeled and sent for permanent pathology. Postoperative instructions address wound care, activity restrictions, and signs of complications. Coding for this service uses 11626 when the malignant lesion plus margins exceeds 4.0 cm on one of the specified anatomic sites.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typical for 11626 (e.g., extensive dissection, complex hemostasis, prolonged procedure beyond usual complexity). |
50 | Bilateral procedure | Use when two symmetric anatomic sites are excised in the same operative session and payor accepts bilateral modifier for skin procedures. |
51 | Multiple procedures | Use when 11626 is billed with additional distinct procedures during the same session (report multiple procedures per payer rules). |
52 | Reduced services | Use when the procedure is partially reduced or not completed as originally planned. |
53 | Discontinued procedure | Use when procedure is started but terminated due to extenuating circumstances. |
59 | Distinct procedural service | Use to indicate a separate and distinct procedure or site when another CPT is reported the same day and NCCI edits apply. |
62 | Two surgeons | Use when two surgeons of different specialties work together as primary surgeons performing distinct portions of the excision/reconstruction. |
66 | Surgical team | Use when multiple specialists participate as an organized team for complex reconstruction after excision. |
76 | Repeat procedure by same physician | Use when the same physician repeats the procedure subsequent to an earlier attempt during the same day (Note: 76 not in provided list; excluded). |
78 | Return to OR for related procedure during postoperative period | Use when patient returns to the operating room for a complication related to the initial surgery during the global period. |
79 | Unrelated procedure or service by same physician during postoperative period | Use when an unrelated procedure is performed during the global period. |
LT | Left side | Use to designate left anatomic site when laterality reporting is required for payor adjudication. |
RT | Right side | Use to designate right anatomic site when laterality reporting is required for payor adjudication. |
GC | Service performed in part by resident under direction of teaching physician | Use when a portion of the procedure is performed by a resident with the teaching physician present and meeting documentation requirements. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207RX0000X | Dermatology | Most common specialty performing cutaneous cancer excisions on scalp, neck, hands, feet, genitalia. |
207XS0101X | Dermatologic Surgery | Subspecialty focus on complex skin oncology and reconstructive techniques. |
208800000X | General Surgery | Performs large or complex skin and soft tissue excisions and reconstruction. |
2080P0202X | Otolaryngology (ENT) | Commonly treats scalp/neck lesions and head & neck reconstruction. |
207K00000X | Plastic Surgery | Frequently performs reconstruction (flaps, grafts) after large oncologic excisions. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
C44.219 | Squamous cell carcinoma of skin of unspecified part of face | SCC is a common cutaneous malignancy that may require wide excision when large or on high-risk sites. |
C44.019 | Basal cell carcinoma of skin of unspecified part of head and neck | BCC on scalp/neck may necessitate excision with margins; large lesions qualify for 11626 by size/site. |
C60.9 | Malignant neoplasm of penis, unspecified | Malignancies of genitalia that are cutaneous or superficial may require excision per 11626 when >4.0 cm. |
C51.9 | Malignant neoplasm of vulva, unspecified | Large vulvar skin cancers on genitalia site where 11626 applies. |
C44.512 | Squamous cell carcinoma of skin of left hand | Hand lesions are specifically listed for 11626 and may require complex excision. |
C44.611 | Basal cell carcinoma of skin of right foot | Foot is a listed anatomic site; lesions >4.0 cm meet 11626 criteria. |
C79.31 | Secondary malignant neoplasm of skin of scalp and neck | Metastatic skin deposits in these regions may be excised for palliation or control when >4.0 cm. |
D04.9 | Carcinoma in situ of skin, unspecified | In select situations carcinoma in situ of large size on listed sites may be managed surgically with wide local excision. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
11606 | Excision, malignant lesion including margins; scalp, neck, hands, feet, or genitalia; 2.1 cm to 3.0 cm | Used for smaller malignant lesions on same anatomic sites when lesion size falls in a lower size range than 11626. |
11626 | Excision, malignant lesion including margins; scalp, neck, hands, feet, or genitalia; over 4.0 cm | Primary procedure for excision of malignant lesions >4.0 cm on specified sites. |
14040 | Adjacent tissue transfer or rearrangement, forehead/eyelids/nose/lips, up to 25 cm2 | Reconstruction option for closure of large defects on head/neck following excision when local flap is required. |
15271 | Skin graft, full-thickness; forehead, cheeks, nose, eyelids, lips, chin, mouth, neck, ears, orbits, genitalia, hands or feet; first 10 cm2 | Used when defect requires full-thickness grafting after excision. |
88305 | Surgical pathology, gross and microscopic examination | Used for permanent pathology evaluation of the excised specimen to confirm margin status and diagnosis. |
99213 | Office visit, established patient, low to moderate complexity | Preoperative or postoperative office visit commonly billed in the perioperative period for assessment and wound checks. |