CPT 11401Surgery

Exc tr-ext b9+marg 0.6-1 cm

CPT 11401 covers the removal of a benign (non-cancerous) skin growth from the face, neck, hands, feet, or genitals when the growth measures between 0.6 and 1.0 centimeters (about 1/4 to 1/2 inch) including the margin removed around it.

Showing rates for

National Average

Base Medicare rate

$151.06

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

1.28

PE RVU (NF)

3.23

MP RVU

0.16

Total RVU

4.67

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

NCCI bundling edits

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Billing tips

Measure the excised diameter (lesion plus margins) not the lesion alone. Document both pre-excision lesion size and post-excision specimen size in the operative note.
Impact: Prevents $40-60 downcoding from 11401 to 11400; incorrect measurement is the #1 reason for code-level denials
Bill in non-facility settings when possible. The practice receives the facility fee component of the RVU.
Impact: Increases reimbursement by $47.23 per procedure (difference between $151.06 non-facility and $103.83 facility rate)
When performing multiple excisions, list them in descending RVU order with modifier 51 on secondary procedures to maximize reimbursement.
Impact: Ensures highest-paying procedure receives 100% payment; can affect total reimbursement by 10-15% when billing 3+ excisions
Ensure pathology reports confirm benign diagnosis. If pathology reveals malignancy, submit corrected claim with appropriate malignant excision code (11600 series).
Impact: Malignant excision codes reimburse 15-30% higher; timely correction within filing limits prevents revenue loss of $30-80 per case
Verify anatomic site carefully. Lesions on face, ears, eyelids, nose, lips, or mucous membranes use 11440 series codes with higher reimbursement.
Impact: Face/special site codes reimburse approximately $175-225 vs $151 for 11401; misclassification costs $24-74 per procedure
Document medical necessity clearly, especially for cosmetic-appearing lesions. Include symptoms (bleeding, irritation, catching on clothing) or clinical concern for transformation.
Reduces denial rate by 25-40%; cosmetic denials result in 100% revenue loss ($151.06) and patient satisfaction issues

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 11401 in 2025?

The 2025 Medicare national average reimbursement for CPT 11401 is $151.06 in non-facility settings (office) and $103.83 in facility settings (hospital outpatient). Actual rates vary by geographic location based on GPCI adjustments. The code has a total RVU value of 4.67.

How do you measure lesion size for CPT 11401 billing?

CPT 11401 requires measurement of the excised diameter (lesion plus margins removed), not just the lesion itself. The total excised specimen must measure 0.6 to 1.0 cm. Measure the greatest clinical diameter before excision, then confirm the excised specimen diameter. Document both measurements in the operative note.

Can you bill an E/M visit with CPT 11401 on the same day?

Yes, you can bill an E/M service with CPT 11401 on the same day if the E/M represents a separately identifiable service beyond the normal pre-procedure evaluation. Append modifier 25 to the E/M code and ensure documentation clearly shows the E/M addressed distinct problems or included significant additional history, examination, or medical decision-making.

What body locations are appropriate for CPT 11401?

CPT 11401 is used for lesions on the trunk, arms, and legs (excluding hands, feet, and genitalia). Lesions on the face, ears, eyelids, nose, lips, or mucous membranes require codes from the 11440 series. Lesions on hands, feet, or genitalia use codes from the 11420 series. Proper anatomic site selection is critical for correct reimbursement.

What is the difference between CPT 11401 and 11400?

The difference is the excised diameter size: CPT 11400 covers excisions 0.5 cm or less, while CPT 11401 covers 0.6 to 1.0 cm. Both codes apply to the same anatomic sites (trunk/extremities). The excised diameter includes the lesion plus margins. CPT 11401 reimburses approximately $40-50 more than 11400, making accurate measurement documentation essential.

Does CPT 11401 include pathology services?

No, CPT 11401 covers only the excision procedure and simple closure. Pathology examination is billed separately using appropriate pathology CPT codes (typically 88305 for skin lesion pathology). The surgical pathology code is billable by the pathologist or laboratory, not the performing physician, unless the practice owns the pathology lab.

How many times can you bill CPT 11401 in one session?

You can bill CPT 11401 multiple times in one session if multiple separate lesions meeting the size criteria are excised. Apply modifier 51 to secondary procedures, or use modifier 59 if needed to indicate distinct sites. List procedures in descending RVU order. Medicare and most payers reduce payment by 50% on secondary procedures. Document each lesion's location, size, and characteristics separately.