2025 CPT code 11626
(Active) Effective Date: N/A Revision Date: N/A Surgery - Excision-Malignant Lesions Procedures on the Skin Surgery Feed
Excision of malignant skin lesion, including margins; excised diameter over 4.0 cm.
Modifiers 58 (staged or related procedure) and 59 (distinct procedural service) may be applicable depending on the circumstances.Consult the most current CPT guidelines for modifier usage.
Medical necessity is established by the presence of a malignant skin lesion requiring surgical excision for complete removal and prevention of further spread or local tissue destruction.Documentation of the lesion's characteristics and the clinical rationale for excision is crucial.
The physician is responsible for the surgical excision of the malignant lesion, including determining appropriate margins, performing the excision, controlling bleeding, and performing the closure.Pathology consultation may be required.Postoperative care is generally included within the global surgical period.
In simple words: The doctor removes a cancerous growth from the skin on your scalp, neck, hands, feet, or genitals. The growth and a small area of surrounding skin are removed. The doctor stitches up the area afterward.
This CPT code encompasses the surgical excision of a malignant lesion from the skin of the scalp, neck, hands, feet, or genitalia,measuring greater than 4.0 cm in diameter, including margins.The procedure involves full-thickness removal of the lesion and surrounding tissue, followed by simple closure.If more complex closure is needed, additional codes are required.The size is determined pre-excision, representing the lesion diameter plus the narrowest margin necessary for complete excision.
Example 1: A 65-year-old male presents with a 5 cm basal cell carcinoma on his scalp.The physician excises the lesion with a 5mm margin, resulting in a 6cm excised diameter. Simple closure is performed., A 72-year-old female presents with a 4.5 cm melanoma on her left hand.A 4 mm margin is removed, leading to a 5.3 cm excised diameter. The wound requires intermediate closure due to its location and size., A 50-year-old male has a 4.2 cm squamous cell carcinoma on his neck that requires a 6 mm margin for adequate excision (5 cm diameter + 6 mm margin).The final excised diameter is 5.6 cm. Following excision, the wound is closed with sutures.A frozen section is done to confirm negative margins.
* Pre-operative assessment and diagnosis (including imaging, biopsy results).* Detailed description of the lesion's size and location.* Measurement of the excised diameter (lesion + margin).* Documentation of the surgical technique.* Pathology report confirming the diagnosis and margin status.* Post-operative instructions and follow-up plan.
** The diameter measurement should be made prior to excision.Accurate documentation is paramount for appropriate reimbursement.Always verify payer-specific requirements and local coverage determination (LCD) policies.
- Revenue Code: P5A (Ambulatory Procedures - Skin)
- RVU: 8.59 RVUs (4.61 work RVUs) (Facility based)
- Global Days: The global period is not explicitly defined for this code but is likely influenced by the complexity of the excision and closure.Consult payer-specific guidelines for details.
- Payment Status: Active
- Modifier TC rule: Not applicable. This code represents the entire procedure.
- Fee Schedule: Fee schedules vary widely based on payer, location, and other factors.Historical fee data is unavailable but can often be obtained through specialized medical billing resources.
- Specialties:* Dermatology* Surgical Oncology* Plastic Surgery
- Place of Service:Office, Ambulatory Surgical Center, Hospital (Inpatient or Outpatient)