CPT 11305Surgery

Shave skin lesion 0.5 cm/<

CPT code 11305 covers the shaving or horizontal removal of a small skin lesion (less than 0.5 centimeters in diameter) such as a mole, skin tag, or superficial growth. This is a minor surgical procedure typically performed in an office setting with local anesthesia.

Showing rates for

National Average

Base Medicare rate

$100.27

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

0.8

PE RVU (NF)

2.24

MP RVU

0.06

Total RVU

3.1

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

NCCI bundling edits

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Billing tips

Measure and document lesion size in millimeters before infiltration of anesthesia, as anesthetic can distort tissue and artificially increase measured size
Impact: Prevents downcoding from 11306 or 11307 to 11305, protecting up to $50-100 in reimbursement per lesion
Bill in non-facility settings (office) when possible to receive the $100.27 rate versus the $35.90 facility rate
Impact: Increases reimbursement by $64.37 per procedure (179% higher payment) by choosing appropriate service location
Use modifier 25 when same-day E/M services are provided and separately documented, but ensure the E/M note clearly documents medical necessity beyond the minor procedure
Impact: Captures additional $75-200 in E/M reimbursement that would otherwise be lost; however, weak documentation invites audits
Send all shave specimens to pathology and reference the pathology report number in your documentation to support medical necessity and distinguish from cosmetic procedures
Impact: Strengthens medical necessity defense against denials and supports payment; cosmetic removals are patient-pay and typically denied by all payers
When removing multiple lesions, bill each lesion separately using the appropriate size-based code (11305, 11306, or 11307) rather than using unlisted codes or bundling
Impact: Medicare and most commercial payers allow separate payment for each lesion; failure to bill separately can result in 50-75% revenue loss when multiple lesions are treated
Document the specific anatomic location (e.g., 'posterior upper back, 3 cm left of midline') for each lesion to support multiple units if questioned

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Frequently asked questions

What is the Medicare reimbursement for CPT code 11305 in 2025?

The 2025 Medicare national average reimbursement for CPT 11305 is $100.27 in non-facility settings (physician office) and $35.90 in facility settings (hospital outpatient department or ASC). Actual payment may vary by geographic locality based on the GPCI adjustment factors.

How many RVUs is CPT code 11305 worth?

CPT 11305 has a total of 3.1 RVUs for 2025, broken down as: 0.8 work RVUs, 2.24 non-facility practice expense RVUs (0.25 facility PE RVUs), and 0.06 malpractice RVUs. These values are from the CMS Physician Fee Schedule RVU25A released December 23, 2024.

Can I bill an office visit and CPT 11305 on the same day?

Yes, you can bill both an E/M service and CPT 11305 on the same day, but you must append modifier 25 to the E/M code and ensure your documentation supports that the office visit was a separately identifiable service beyond the minor procedure. The E/M note should address concerns or conditions beyond the skin lesion removal itself.

What is the difference between CPT 11305 and 11306?

The only difference is lesion size: CPT 11305 is for lesions less than 0.5 cm in diameter, while 11306 covers lesions 0.5 to 1.0 cm. Both codes are for shave removal of lesions on the trunk, arms, or legs. Accurate measurement before anesthetic infiltration is critical for proper code selection.

Does CPT 11305 include pathology fees?

No, CPT 11305 covers only the shave removal procedure itself. Pathology services must be billed separately by the pathologist using the appropriate pathology CPT codes (typically 88305 for surgical pathology, level IV for skin lesions). The dermatologist or surgeon bills 11305; the pathology lab bills the path code.

How many times can I bill CPT 11305 on the same day?

You can bill CPT 11305 multiple times on the same day if multiple separate lesions are removed, each meeting the size and location criteria. Document each lesion's size and specific anatomic location separately. Most payers do not limit the number of lesion removals per day, but some may apply modifier 59 or request additional documentation for more than 3-4 lesions.

Is CPT 11305 covered by Medicare for cosmetic reasons?

No, Medicare and most insurers do not cover CPT 11305 for purely cosmetic reasons. Medical necessity must be documented, such as bleeding, irritation, catching on clothing, diagnostic uncertainty, changing features, or premalignant characteristics. When removal is purely for cosmetic reasons, the patient should be informed of non-coverage and charged directly.