CPT 11402Surgery

Exc tr-ext b9+marg 1.1-2 cm

CPT 11402 covers the surgical removal of a benign (non-cancerous) skin growth from the trunk, arms, legs, hands, feet, or genitals when the lesion measures 1.1 to 2.0 centimeters in diameter, including a small margin of normal tissue around it.

Showing rates for

National Average

Base Medicare rate

$166.91

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

1.45

PE RVU (NF)

3.53

MP RVU

0.18

Total RVU

5.16

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

NCCI bundling edits

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Billing tips

Measure the lesion diameter plus margins after excision, not pre-operative size - the excised diameter determines code selection
Impact: Incorrect measurement can shift billing to 11401 (≤1.0 cm, pays $113.54 non-facility) or 11403 (2.1-3.0 cm, pays $199.36 non-facility), resulting in $53.37-$32.45 payment variance
Document anatomic location precisely - 11402 is only for trunk/extremities/hands/feet/genitals; face/ears/lips/nose/eyelids require 11442 series which pays differently
Impact: Using wrong anatomic series (11442 pays $201.13 non-facility vs $166.91 for 11402) triggers audits and potential fraud allegations; exact location must be in operative note
Bill based on facility vs non-facility setting correctly - office-based procedures qualify for non-facility rate ($166.91) while hospital outpatient uses facility rate ($113.54)
Impact: Site-of-service differential is $53.37 per procedure; incorrect POS code results in automatic downcoding and 32% payment reduction
Send pathology report confirming benign diagnosis - if malignant, must use 11602 series for malignant excision which has different payment structure
Impact: Malignant lesion excision codes (11602 series) have different global periods and payment rates; using wrong series after pathology results can constitute fraudulent billing
When billing multiple excisions, sequence the highest RVU/payment code first and apply modifier 51 to subsequent codes
Impact: First code pays 100%; subsequent codes pay 50%; improper sequencing costs approximately $56-83 per additional lesion depending on sizes excised
Verify global period (10 days for 11402) before billing E/M services during postoperative window - only complications/unrelated conditions qualify

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 11402 in 2025?

The 2025 Medicare national average payment for CPT 11402 is $166.91 for non-facility (office) settings and $113.54 for facility (hospital outpatient) settings. These rates are based on a total RVU of 5.16 and a conversion factor of 32.3465. Actual payment may vary by geographic locality based on Medicare's Geographic Practice Cost Index (GPCI) adjustments.

How do I measure lesion size correctly for CPT 11402 coding?

CPT 11402 requires measuring the excised diameter (lesion plus margins) after removal, not the pre-operative size. The specimen must measure 1.1 to 2.0 cm in greatest diameter. Use calipers or a ruler to measure the tissue specimen and document this measurement in the operative note. If the lesion alone is 1.5 cm but margins add 0.3 cm on each side, the total excised diameter is 2.1 cm, which requires code 11403 instead.

Can I bill CPT 11402 for a lesion on the face?

No, CPT 11402 is specifically for benign lesions on the trunk, arms, legs, hands, feet, neck, scalp, and genitals. Lesions on the face, ears, eyelids, nose, lips, and mucous membranes require the 11440-11446 series codes instead. Using the wrong anatomic series is a common billing error that triggers claim denials and audits.

What modifiers are commonly used with CPT code 11402?

The most common modifiers for 11402 are: modifier 25 (significant separate E/M service same day), modifier 51 (multiple procedures when excising several lesions), modifier 59 (distinct procedural service for separate anatomic sites), and modifiers LT/RT (left/right side specification). Modifier 25 requires clear documentation that the E/M service was separately identifiable from the excision decision.

Is CPT 11402 used for malignant or benign lesions?

CPT 11402 is exclusively for benign (non-cancerous) lesions. If pathology returns showing malignancy (basal cell carcinoma, squamous cell carcinoma, melanoma), you should not use 11402. Malignant lesion excisions on the trunk/extremities require codes from the 11600-11606 series. If the clinical impression was benign but pathology shows malignancy, contact the payer about correcting the claim to the appropriate malignant excision code.

How many times can I bill CPT 11402 on the same day?

You can bill 11402 multiple times on the same date of service if multiple distinct lesions meeting the size criteria (1.1-2.0 cm excised diameter) are removed from different anatomic sites. Apply modifier 51 to the second and subsequent codes, or use modifier 59 if needed to demonstrate distinct sites. Each excision must be separately documented with individual measurements and locations. The first code pays at 100%, subsequent codes typically at 50%.

What is the global period for CPT 11402?

CPT 11402 has a 10-day global period. This means all routine postoperative care for 10 days following the procedure is included in the payment and cannot be billed separately. E/M services during this period are only billable if they address unrelated conditions (modifier 24) or complications beyond normal post-op care. Suture removal within the global period is included and not separately reimbursable.