CPT 11311Surgery

Shave skin lesion 0.6-1.0 cm

CPT code 11311 is used when a doctor shaves off a skin growth or lesion that measures between 0.6 and 1.0 centimeters (about the size of a pencil eraser). This is a simple office procedure where the lesion is removed at skin level without deep cutting or stitches.

Showing rates for

National Average

Base Medicare rate

$131.65

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

1.1

PE RVU (NF)

2.84

MP RVU

0.13

Total RVU

4.07

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

NCCI bundling edits

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Billing tips

Measure lesions before anesthesia injection and document exact size in millimeters or centimeters in the procedure note
Impact: Prevents downcoding from 11311 ($131.65) to 11310 ($106.89), protecting $24.76 per procedure, or upcoding audits if lesion is actually smaller
Bill non-facility (office) place of service when performed in your clinic rather than hospital outpatient to capture the $70.84 rate difference
Impact: Increases reimbursement from $60.81 to $131.65 per procedure—a 116% payment increase for proper POS coding
Use modifier 25 with appropriate documentation when performing same-day E/M for new problems unrelated to the lesion removal decision
Impact: Captures additional $50-200 for E/M service that would otherwise be bundled and denied; requires clearly documented separate medical necessity
For multiple lesions, list each separately with size and anatomic location; apply modifier 51 or 59 as appropriate to secondary procedures
Impact: Multiple 11311 codes paid at 100% for first lesion, 50% for additional lesions; poor documentation results in denial of all but one
Submit pathology report with claim or have readily available for audit showing benign diagnosis to support medical necessity
Impact: Prevents denials for cosmetic exclusion; some payers require pathology confirmation within 30 days or retroactively deny payment
Verify that lesion size is truly 0.6-1.0 cm; if less than 0.6 cm use 11310, if 1.1-2.0 cm use 11312 to ensure correct code assignment
Impact: 11310 pays $106.89, 11311 pays $131.65, 11312 pays $158.07; using correct code based on size prevents $24.76-$51.18 payment errors

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 11311 in 2025?

The 2025 Medicare national average reimbursement for CPT 11311 is $131.65 for non-facility settings (office) and $60.81 for facility settings (hospital outpatient), based on the CMS Physician Fee Schedule with a conversion factor of 32.3465. Actual payment varies by geographic locality and MAC.

How many RVUs is CPT code 11311 worth?

CPT 11311 has a total of 4.07 RVUs broken down as: 1.1 work RVUs, 2.84 practice expense RVUs (non-facility), 0.65 practice expense RVUs (facility), and 0.13 malpractice RVUs. The facility total RVU is 1.88 while non-facility total is 4.07.

What size lesion qualifies for CPT code 11311?

CPT 11311 is specifically for shave removal of lesions measuring 0.6 to 1.0 centimeters in diameter. Lesions smaller than 0.6 cm should be coded as 11310, while lesions 1.1 to 2.0 cm should be coded as 11312. Accurate pre-procedure measurement documentation is essential for proper code selection.

Can I bill an office visit with CPT 11311 on the same day?

Yes, you can bill an E/M service with 11311 using modifier 25, but only if the E/M represents a significant, separately identifiable service beyond the normal pre-procedure evaluation. The E/M must address a different problem or involve substantial evaluation unrelated to the decision for lesion removal. Documentation must clearly support separate medical necessity.

How do I bill for multiple lesion removals using CPT 11311?

Bill 11311 separately for each lesion in the 0.6-1.0 cm size range with distinct anatomic locations documented. The first lesion is paid at 100%, and subsequent lesions typically receive 50% payment reduction per Medicare multiple procedure rules. Use modifier 59, 76, or anatomic modifiers (LT/RT) as appropriate to indicate separate sites and prevent duplicate denials.

Does CPT 11311 require pathology to be sent for reimbursement?

While CPT 11311 does not explicitly require pathology submission, many payers require pathology confirmation of benign or premalignant diagnosis to establish medical necessity and rule out cosmetic exclusions. Best practice is to send all specimens to pathology and maintain reports for potential audits, especially for lesions removed for medical indications rather than symptomatic complaints.

What is the difference between CPT 11311 and 11312?

The only difference is lesion size: CPT 11311 covers shave removal of lesions 0.6-1.0 cm in diameter (pays $131.65 non-facility), while CPT 11312 covers lesions 1.1-2.0 cm (pays $158.07 non-facility). Both use identical technique and anatomic location (trunk, arms, legs, scalp, neck, hands, feet, genitalia). Accurate size measurement determines correct code assignment and a $26.42 payment difference.