CPT 11310Surgery

Shave skin lesion 0.5 cm/<

CPT code 11310 is used when a doctor shaves off a small skin growth or lesion that is less than 0.5 centimeters (about the size of a pencil eraser tip) using a blade or similar instrument.

Showing rates for

National Average

Base Medicare rate

$110.30

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)

2.53

MP RVU

0.08

Total RVU

3.41

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

NCCI bundling edits

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Billing tips

Measure and document lesion size precisely before removal, not after. The largest diameter must be less than 0.5 cm to justify 11310; if 0.5 cm or larger, use 11311 instead.
Impact: Using 11311 instead of 11310 for appropriate-sized lesions increases reimbursement by approximately $20-30 (non-facility Medicare rates). Incorrect upcoding can trigger audits and recoupment.
Document the anatomic location of each lesion with specific detail (e.g., 'left upper back, 3 cm lateral to midline' rather than just 'back') to support medical necessity and multiple procedure billing.
Impact: Specific anatomic documentation reduces denial rate for multiple procedures by 30-40% and supports modifier 59 when needed for distinct sites.
Send specimens for pathology when there is any clinical suspicion of malignancy or when patient/clinical history warrants histologic examination; document medical necessity for biopsy.
Impact: Pathology adds approximately $45-85 to total reimbursement (88305 for skin biopsy) and provides essential documentation for medical necessity. Lack of pathology on suspicious lesions can trigger quality-of-care concerns.
Use time-of-service photography to document lesion size, morphology, and location before removal, particularly for cosmetic versus medical necessity determination.
Impact: Photo documentation reduces medical necessity denials by approximately 25% and provides definitive audit defense. Essential when billing multiple lesions or when medical necessity may be questioned.
Bill 11310 only once per lesion regardless of number of shaves required; do not bill multiple units for a single lesion that required several passes to remove completely.
Impact: Prevents upcoding denials and potential fraud investigations. Multiple units for single lesion removal can result in 100% recoupment of overpayment plus potential penalties.

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 11310 in 2025?

The 2025 Medicare national average reimbursement for CPT 11310 is $110.30 for non-facility (office) settings and $43.67 for facility settings (hospital outpatient or ASC). These rates are based on a conversion factor of 32.3465 and total RVU of 3.41. Actual reimbursement may vary by geographic locality based on the GPCI (Geographic Practice Cost Index) adjustment.

How many times can you bill CPT 11310 on the same day?

You can bill CPT 11310 multiple times on the same day if multiple distinct lesions are removed, each measuring less than 0.5 cm. Each lesion must be documented separately with specific anatomic locations. Modifier 51 (multiple procedures) is typically applied to the second and subsequent procedures, which are usually reimbursed at 50% of the primary procedure rate. Do not bill 11310 multiple times for a single lesion that required multiple shaves to remove.

What is the difference between CPT 11310 and 11311?

The difference is lesion size: CPT 11310 is for shave removal of lesions less than 0.5 cm in diameter, while CPT 11311 is for lesions 0.5 to 1.0 cm. The size must be measured and documented before removal. CPT 11311 reimburses at a higher rate (approximately $20-30 more for Medicare). Using the wrong code based on documented size can result in denials or recoupment during audits.

Can you bill an E/M visit with CPT 11310 on the same day?

Yes, you can bill an E/M service with CPT 11310 on the same day, but you must append modifier 25 to the E/M code and document that the E/M was a separately identifiable service. The documentation must show the evaluation went beyond the work inherent in deciding to perform the shave removal. If the patient came solely for a pre-planned lesion removal, an E/M is typically not separately billable.

Does CPT 11310 include pathology or is that billed separately?

CPT 11310 does not include pathology services; these are billed separately. If the specimen is sent for histopathologic examination, you would typically also bill CPT 88305 (surgical pathology, skin biopsy). The pathology service is usually billed by the pathologist or laboratory, not the performing physician, unless the practice has an in-house laboratory with appropriate CLIA certification.

What documentation is required to support medical necessity for CPT 11310?

Medical necessity documentation should include the reason for removal such as symptomatic lesion (bleeding, irritation, pain), clinical concern for malignancy based on appearance or change, patient history of skin cancer, or need for diagnostic biopsy. Cosmetic removal is generally not covered by insurance. Document specific symptoms, clinical findings, risk factors, and the medical decision-making process that led to the procedure.

What are the RVUs for CPT code 11310 in 2025?

For 2025, CPT 11310 has a Work RVU of 0.8, Practice Expense RVU of 2.53 (non-facility) or 0.47 (facility), and Malpractice RVU of 0.08, for a total RVU of 3.41 (non-facility) or 1.35 (facility). These values are from the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024. The conversion factor of 32.3465 is applied to these RVUs to determine the dollar reimbursement amount.