CPT 11922: Medical Tattooing for Permanent Camouflage of Skin Defects - OpenPayer

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Summary & Overview

CPT 11922: Medical Tattooing for Permanent Camouflage of Skin Defects

CPT code 11922 designates additional surface area for medical tattooing used to provide permanent camouflage of skin color defects caused by congenital anomalies, breast reconstruction, burns, vitiligo, birthmarks, and similar conditions. The code applies to each additional 20.0 cm2, or part thereof, beyond the initial treated 20.0 cm2, making it a unit-based add-on for procedures where pigment implantation covers larger areas. Nationally, this code matters for clinicians in dermatology and plastic surgery and for payers managing coverage and payment for reconstructive and restorative services.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for use of CPT code 11922, typical sites of service, and the unit-based nature of the code. The publication also summarizes benchmarks and payer policy patterns where available, highlights relevant coding practice considerations for surface-area billing, and outlines how this code fits within reconstructive and dermatologic service lines. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 11922medical tattooingdermatologic reconstructionplastic surgerypermanent camouflagesurface-area billingambulatory surgeryoutpatient dermatologyprocedure coding

Billing Code Overview

CPT code 11922 describes a dermatologic tattooing procedure that implants intradermal insoluble opaque pigments to correct skin color defects. The procedure is intended as a permanent camouflage for defects arising from congenital anomalies, breast reconstruction, burns, vitiligo, birthmarks, and similar conditions. CPT code 11922 represents each additional 20.0 cm2, or part thereof, after the first 20.0 cm2.

Service type: Medical tattooing / permanent camouflage for skin defects

Typical site of service: Outpatient dermatology clinic, plastic surgery clinic, or ambulatory surgery center

Clinical & Coding Specifications

Clinical Context

A 38-year-old female presents to a dermatologic surgical clinic several months after unilateral mastectomy and implant-based breast reconstruction. She requests areola complex pigmentation to restore symmetry and camouflage the surgical site. The provider evaluates the reconstructed breast, discusses expectations and risks of intradermal pigment implantation (medical tattooing/microvascular pigment placement), confirms no active infection or uncontrolled bleeding disorder, obtains informed consent, and schedules the procedure. On the day of service the patient is positioned in a minor procedure room or ambulatory surgery center; local anesthesia is administered as needed. The provider applies intradermal insoluble opaque pigments to the reconstructed areola and nipple area. If the treated surface exceeds the initial 20.0 cm2, billing uses 11921 for the first 20.0 cm2 and 11922 for each additional 20.0 cm2 or part thereof. The typical site of service is an outpatient dermatology or plastic surgery clinic, ambulatory surgical center, or physician office procedure room. Post-procedure instructions address wound care, pigment maturation, and a follow-up visit for touch-ups if needed.

Coding Specifications

Modifier	Description	When to Use
`11`	Normal bilateral or usual preoperative service

Taxonomy Code	Specialty	Notes
208Z00000X	Plastic Surgery	Commonly performs reconstructive tattooing after breast reconstruction and scar camouflage.
207N00000X	Dermatology	Performs medical tattooing for vitiligo, scar camouflage, and pigment restoration.
208200000X	General Surgery (Breast Surgery)	Breast surgeons may coordinate or perform areolar reconstruction procedures or refer for tattooing.
363L00000X	Nurse Practitioner	NPs in dermatology or plastic surgery clinics may perform or assist with medical tattooing where state scope allows.
367500000X	Physician Assistant	PAs commonly participate in procedural services and follow-up care in outpatient settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`L91.8`	Other hypertrophic disorders of skin	Scar-related pigment camouflage after abnormal scar formation where tattooing can mask irregular pigmentation.
`L80`	Vitiligo	Pigment restoration to repigment depigmented skin areas for cosmetic and psychosocial benefit.
`T30.1`	Burn of chest, superficial partial-thickness	Post-burn hypopigmentation or scarring remedied by medical tattooing for camouflage.
`Q82.5`	Congenital melanocytic nevus	Residual pigment irregularity or post-excision color defects corrected with intradermal pigmentation.
`Z42.1`	Encounter for breast reconstruction following mastectomy	Areolar and nipple tattooing commonly performed as a final stage of breast reconstruction.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11921`	Tattooing of skin for cosmetic purposes, intradermal introduction of insoluble opaque pigments; first 20.0 sq cm or less, or part thereof	Represents the initial unit for medical/camouflage tattooing; `11922` is billed for each additional 20.0 cm2 or part thereof beyond this base unit.
`15780`	Full-thickness skin graft, trunk, arms, legs; first 100 sq cm or each additional 25 sq cm	Performed when reconstruction requires grafting prior to or instead of pigment camouflage; may be in the broader reconstructive pathway.
`19318`	Reduction mammaplasty	Included as an example of breast procedures in the reconstructive spectrum that may precede or follow areolar tattooing in staged care plans.
`14000`	Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or less	Soft tissue rearrangement and scar revision procedures that may be performed before pigment restoration to improve outcomes.
`99070`	Supplies and materials (e.g., sterile, single-use) provided by physician over and above those usually included with the office visit or procedure	Used to report additional supplies (pigments, specialized disposables) when payer allows separate supply reimbursement.