2025 CPT code 11403
(Active) Effective Date: N/A Revision Date: N/A Surgery - Excision-Benign Lesions Procedures on the Skin Surgery Feed
Excision of a benign skin lesion (excluding skin tags) with a diameter of 2.1 to 3.0 cm, including margins, from the trunk, arms, or legs, with simple closure.
Modifiers such as 59 (Distinct Procedural Service) may be applicable when multiple lesions are excised during the same session, or when additional services are provided.Consult the official CPT manual for specific modifier usage guidelines.
Medical necessity is established when the lesion is symptomatic (e.g., painful, itchy, or cosmetically undesirable), or if there is concern for malignancy (although this code is for benign lesions).Documentation must support the clinical justification for the excision.
The clinical responsibility involves proper patient preparation, local anesthesia, precise excision of the lesion with appropriate margins, hemostasis (control of bleeding), and simple closure of the wound.The excised tissue may be sent for pathological examination.
In simple words: The doctor cuts out a non-cancerous growth (not a skin tag) on your body (trunk, arms, or legs) that's about 2.1 to 3 centimeters wide, including a little extra skin around it to make sure it's all gone.They then stitch up the area with a simple closure.
This CPT code (11403) describes the surgical excision of a benign lesion (excluding skin tags) from the skin of the trunk, arms, or legs. The greatest clinical diameter of the lesion, plus the necessary margin for complete excision, measures between 2.1 and 3.0 cm. The procedure involves full-thickness removal of the lesion through the dermis and includes simple, non-layered closure.Each lesion excised is reported separately.More complex closures require additional coding.
Example 1: A 45-year-old female presents with a 2.5 cm benign nevus on her left upper arm. The physician excises the lesion with a 2mm margin, and performs simple closure., A 60-year-old male presents with a 2.8 cm seborrheic keratosis on his back. The physician excises the lesion with a 3mm margin, and performs simple closure. A pathology specimen is sent for analysis., A 22-year-old female presents with two benign lesions on her left leg measuring 2.2 cm and 2.9 cm respectively. The physician excises both lesions separately. Modifier 59 is added to the second code.
Complete medical history, physical examination findings noting the lesion's location, size, and characteristics.Preoperative and postoperative photographs are recommended, along with documentation of the excision technique (including margins), tissue handling, closure method, and pathology report (if applicable).
** Accurate measurement of the lesion and margins is crucial for correct code selection.The clinical judgment of the physician is paramount in determining the appropriate code.
- Revenue Code: P5A (AMBULATORY PROCEDURES - SKIN)
- RVU: This information is not provided in the source and would require consultation of a current relative value unit (RVU) database.
- Global Days: The global period information for this code is not included in the source and must be determined based on local payer guidelines.
- Payment Status: Active
- Modifier TC rule: This code does not typically require a Technical Component (TC) modifier.
- Fee Schedule: Historical fee schedule data is not included in the source.This information is available through various commercial medical billing databases and should be checked for your specific region and time period.
- Specialties:Dermatology, Plastic Surgery, General Surgery
- Place of Service:Office, Ambulatory Surgical Center, Hospital Outpatient Department