CPT 11312Surgery

Shave skin lesion 1.1-2.0 cm

CPT 11312 covers shaving off a skin growth or lesion that measures between 1.1 and 2.0 centimeters (roughly the size of a dime to a penny). The physician removes the lesion by shaving it horizontally at or just below the skin surface without going deep into the tissue.

Showing rates for

National Average

Base Medicare rate

$149.76

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

1.3

PE RVU (NF)

3.18

MP RVU

0.15

Total RVU

4.63

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

NCCI bundling edits

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Billing tips

Always measure the lesion's greatest clinical diameter before removal and document in millimeters or centimeters in the procedure note
Impact: Prevents downcoding to 11311 (saves $37.27 Medicare payment) or upcoding accusations if documented as 2.1+ cm
Bill facility (POS 22) vs non-facility (POS 11) correctly based on actual location of service
Impact: $77.63 difference in Medicare reimbursement ($149.76 office vs $72.13 facility); incorrect POS triggers audits
When removing multiple lesions, bill each separately and use modifier 59/XS for different anatomic sites; second and subsequent may receive reduced payment
Impact: Multiple procedure reduction rules apply: 100% for first lesion, typically 50% for second, 50% for third+; proper coding prevents full denial
Submit pathology reports with claims for suspicious lesions to support medical necessity and prevent cosmetic denials
Impact: Significantly reduces denial rate for medical necessity; pathology documenting dysplasia or malignancy justifies procedure
Do not bill 11312 with excision codes (11400-11446 series) for the same lesion; shave removal and excision with closure are mutually exclusive
Impact: NCCI edit will deny one code as bundled; excision codes reimburse higher but require different technique and closure
Link appropriate ICD-10 diagnosis codes indicating benign neoplasm (D22-D23 series), actinic keratosis (L57.0), or other skin lesion to establish medical necessity
Impact: Generic 'lesion' codes or cosmetic diagnosis codes trigger automatic denials; specific diagnosis supports $149.76 payment

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Frequently asked questions

What is the Medicare reimbursement for CPT code 11312 in 2025?

Medicare pays $149.76 for CPT 11312 in non-facility settings (physician office) and $72.13 in facility settings (hospital outpatient or ASC) based on 2025 national average rates. Actual payment varies by geographic locality and MAC jurisdiction.

What size lesion qualifies for CPT code 11312?

CPT 11312 is used for shave removal of lesions measuring 1.1 to 2.0 centimeters in greatest clinical diameter. The measurement must be taken before removal and documented in the medical record. Lesions 1.0 cm or smaller use 11311, while lesions 2.1-3.0 cm use 11313.

Can I bill an E/M visit with CPT 11312 on the same day?

Yes, you can bill an E/M service with 11312 on the same day if the E/M represents a separately identifiable service beyond the usual pre-procedure evaluation. You must append modifier 25 to the E/M code and document the distinct nature of the evaluation (such as comprehensive skin exam, evaluation of other conditions, or detailed history).

How many times can I bill CPT 11312 on the same day?

You can bill 11312 multiple times on the same day for multiple lesions, but you must document each lesion's separate location and size. Use modifier 59 or XS on the second and subsequent procedures to indicate distinct lesions. Most payers apply multiple procedure reduction rules, paying 100% for the first lesion and 50% for additional lesions.

What is the difference between CPT 11312 and excision codes like 11402?

CPT 11312 is a shave removal where the lesion is horizontally cut at or near skin level without deep tissue removal or suture closure. Excision codes (11400-11446 series) involve full-thickness removal including margins with layered closure using sutures. Excision codes reimburse more but require different technique and documentation, and you cannot bill both for the same lesion.

Does CPT 11312 include pathology examination?

No, CPT 11312 only covers the shave removal procedure. If you submit the specimen for pathological examination, you should also bill the appropriate pathology code (typically 88305 for skin lesion pathology). The pathology service is separately billable and reimbursable.

What diagnosis codes support medical necessity for CPT 11312?

Medically necessary diagnoses include benign neoplasms (D22.x-D23.x series), actinic keratosis (L57.0), seborrheic keratosis (L82.x), atypical nevus (D22.x), symptomatic lesions, or rule-out malignancy. Cosmetic diagnosis codes or removal for appearance only typically result in denial. Always link the most specific diagnosis code that reflects clinical findings.