CPT 11201Surgery

Rmvl skin tags ea addl 10

CPT code 11201 is used when a healthcare provider removes additional skin tags beyond the first 15 lesions, billing for each additional 10 skin tags removed during the same session.

Showing rates for

National Average

Base Medicare rate

$17.79

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.29

PE RVU (NF)

0.23

MP RVU

0.03

Total RVU

0.55

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Always bill 11201 in conjunction with primary code 11200; never bill 11201 as a standalone code
Impact: Standalone billing results in automatic denial; proper sequencing ensures base payment of $15.53-$17.79 per unit
Count total lesions accurately and bill 11201 for each full 10 additional lesions beyond the first 15 (e.g., 28 lesions = 11200 x1 + 11201 x1)
Impact: Undercounting by 10 lesions results in loss of $17.79 in non-facility settings; precise documentation maximizes legitimate reimbursement
Verify LCD/NCD policies as many Medicare contractors consider skin tag removal cosmetic and deny coverage unless documentation shows medical necessity (bleeding, irritation, functional impairment)
Impact: Cosmetic denials affect 100% of reimbursement ($17.79 per unit lost); obtain advance beneficiary notice (ABN) when coverage is questionable
Document exact lesion count, anatomic locations, removal method, and medical necessity in the operative note
Impact: Inadequate documentation is the #1 cause of audit recoupment; detailed notes protect against $17.79-$177.90+ in potential takebacks on multiple units
Bill facility vs non-facility based on actual place of service; facility rate is $2.26 lower per unit
Impact: Incorrect POS coding can trigger recoupment of $2.26 per unit billed or underpayment if non-facility services billed as facility
Report 11201 multiple times when appropriate (e.g., 35 total lesions = 11200 x1 + 11201 x2) rather than using unit multipliers incorrectly
Impact: Correct unit reporting ensures full payment; improper unit entry may trigger system edits or reduce payment by $17.79 per missed unit

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 11201 in 2025?

The 2025 Medicare national average reimbursement for CPT 11201 is $17.79 in non-facility settings and $15.53 in facility settings, based on the CMS Physician Fee Schedule with a conversion factor of 32.3465.

Can CPT 11201 be billed without CPT 11200?

No, CPT 11201 is an add-on code that must always be reported in conjunction with primary code 11200. Billing 11201 alone will result in automatic claim denial as it represents additional skin tags beyond the first 15 covered by 11200.

How many skin tags does CPT 11201 represent?

CPT 11201 represents each additional 10 skin tags removed beyond the first 15 lesions. For example, if 28 skin tags are removed, you would bill 11200 (for the first 15) plus 11201 once (for the additional 13, which includes one full group of 10).

Does Medicare cover skin tag removal under CPT 11201?

Medicare coverage for skin tag removal varies by contractor and medical necessity. Many Medicare Administrative Contractors (MACs) consider skin tag removal cosmetic unless documentation shows bleeding, pain, irritation, functional impairment, or trauma. Always check your local coverage determination (LCD) and obtain an Advance Beneficiary Notice (ABN) when coverage is uncertain.

What are the total RVUs for CPT code 11201?

CPT 11201 has a total RVU value of 0.55, consisting of 0.29 work RVU, 0.23 non-facility practice expense RVU (0.16 facility PE RVU), and 0.03 malpractice RVU according to the 2025 Medicare Physician Fee Schedule.

How do you bill for removal of 35 skin tags?

For 35 skin tags, bill CPT 11200 once (covering the first 15 lesions) and CPT 11201 twice (covering two additional groups of 10, accounting for the remaining 20 lesions). Document the exact count of 35 lesions and their locations in the operative note.

What documentation is required to bill CPT 11201?

Required documentation includes the exact total lesion count, specific anatomic locations, removal method used, medical necessity justification (such as symptoms or functional problems), patient consent, and wound care provided. For high-volume removals or questionable medical necessity, photographs significantly strengthen documentation and reduce audit risk.