2025 CPT code 11406
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Integumentary System Surgery Feed
Excision of a benign skin lesion (excluding skin tags) larger than 4.0 cm, including margins, from the trunk, arms, or legs.
Modifiers 22 (increased procedural services), 51 (multiple procedures), and 59 (distinct procedural service) may be applicable depending on the circumstances.
Medical necessity is established by the presence of a symptomatic or cosmetically undesirable benign lesion that warrants surgical excision.Documentation must clearly demonstrate the size and characteristics of the lesion, necessitating the procedure.
The physician is responsible for pre-operative assessment, administering local anesthesia, excising the lesion to appropriate margins, wound hemostasis, and appropriate wound closure.Pathology submission may also be part of the clinical responsibility, depending on local guidelines.
In simple words: The doctor cuts out a non-cancerous skin growth bigger than 4 centimeters, including a little extra skin around it, from the chest, arms, or legs.The doctor numbs the area first and stitches it closed.
This CPT code, 11406, represents the excision of a benign skin lesion, excluding skin tags, with a diameter greater than 4.0 cm, encompassing the necessary margins for complete removal.The procedure includes local anesthesia and simple closure.The lesion's size is measured before excision, considering both the lesion itself and the required margins.The excised diameter remains the same whether the defect is repaired linearly or with reconstruction (e.g., skin graft).If the closure requires intermediate or complex techniques, those should be billed separately using codes 12031-12057 (intermediate) or 13100-13153 (complex), in addition to 11406.For reconstructive closure, use codes 15002-15261 or 15570-15770.This code is not separately billable with adjacent tissue transfer procedures (14000-14302).
Example 1: A 65-year-old male presents with a 5cm benign nevus on his back.The physician excises the lesion, achieving clear margins, and performs a simple closure.Code 11406 is appropriate., A 32-year-old female has a 4.5cm fibroma on her left thigh.Excision with simple closure is performed. Code 11406 is used, with possible modifier 22 if the excision was exceptionally challenging., A 28-year-old male presents with multiple benign lesions on his chest; one measuring 6 cm, one 2cm, and two 1 cm.Code 11406 is used for the 6 cm lesion; 11403 is used for the 2 cm lesion; 11401 is used for each of the 1 cm lesions. Modifier -59 should be used on the secondary codes to indicate separate distinct services.
Complete medical history, physical examination notes, description of the lesion (size, location, type), operative report detailing the technique and margins achieved, pathology report (if applicable), and postoperative notes.Photographs before and after the procedure are helpful.
** Always ensure complete and accurate documentation to support the use of this code and any applied modifiers. Pay close attention to lesion size measurement and closure complexity.
- Revenue Code: P5A (Ambulatory Procedures - Skin)
- RVU: The RVUs for this code vary based on geographic location and payer. Consult your local fee schedule for accurate information.
- Global Days: The global surgical period is not explicitly defined for this code but typically aligns with the principles of local anesthesia and simple closure, implying a shorter global period compared to more extensive surgical procedures.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier is not typically applicable to this code since the entire procedure is usually performed by the physician.
- Fee Schedule: Historical fee schedule data is not readily available within the provided source.Consult your specific payer for fee schedule history.
- Specialties:Dermatology, Plastic Surgery, General Surgery
- Place of Service:Office, Ambulatory Surgical Center, Hospital Outpatient