2025 CPT code 11401
(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) measuring 0.6 to 1.0 cm in diameter, including margins, from the trunk, arms, or legs.
Modifiers may apply in specific clinical scenarios. For example, modifier 59 (distinct procedural service) may be used when multiple lesions are excised. Modifiers 22 (increased procedural services) or 52 (reduced services) may also be used as clinically appropriate.
Medical necessity for excision of benign lesions is generally established by the presence of a lesion that is cosmetically undesirable, symptomatic (e.g., painful, pruritic), or has a potential for malignant transformation. The documentation must clearly support the medical necessity for the procedure based on the patient's clinical presentation.
The physician's responsibility involves pre-operative preparation of the patient, local anesthesia administration, complete excision of the benign lesion including adequate margins, wound hemostasis (control of bleeding), and simple closure of the surgical wound. The physician might also send the excised tissue for pathological examination.
In simple words: The doctor removes a non-cancerous growth (not a skin tag) from your skin on your torso, arms, or legs. The growth is between 0.6 and 1.0 cm wide, and the doctor removes some extra skin around it to make sure it's all gone.They then stitch up the area with a simple stitch.
This CPT code, 11401, represents the excision of a benign lesion (excluding skin tags) with a diameter of 0.6 to 1.0 cm, encompassing the necessary margins for complete removal.The procedure includes local anesthesia and simple closure.The excision is defined as a full-thickness removal (through the dermis).If more complex closure is required, additional codes for intermediate or complex closure must be reported separately.The excised diameter remains consistent regardless of whether the surgical defect is repaired linearly or reconstructed (e.g., with a skin graft). This procedure is not separately reportable with adjacent tissue transfer; only the tissue transfer code should be reported in such cases.
Example 1: A 45-year-old male presents with a 0.8 cm benign nevus on his left forearm. The physician excises the nevus completely, including a 2 mm margin, using a scalpel, and closes the wound with a simple running suture. Code 11401 is applied., A 28-year-old female presents with a 0.7 cm dermatofibroma on her back. The physician performs a full-thickness excision, including a 1 mm margin. After hemostasis is achieved, the wound is closed primarily with simple interrupted sutures. Code 11401 is reported., A 60-year-old male presents with multiple small seborrheic keratoses on his chest, one of which measures 0.9 cm in diameter.The physician excises this lesion and closes the wound with simple interrupted sutures. Due to the multiple lesions, modifier 59 (distinct procedural service) may be applied if multiple excisions are coded.
A complete and accurate medical record should document the size of the lesion (including margins), the location of the lesion, the type of lesion (with histopathological confirmation if possible), the type of closure used (simple), and whether any complications occurred. Preoperative and postoperative photographs are helpful.
** Always ensure accurate measurement of the lesion before selecting the appropriate code.Accurate documentation is essential for appropriate reimbursement.
- Revenue Code: P5A
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier does not typically apply to this code, as the excision of benign lesions usually entails both professional (physician) and technical components that are bundled together.
- Specialties:Dermatology, Plastic Surgery, General Surgery
- Place of Service:Office, Ambulatory Surgical Center, Hospital Outpatient Department