CPT 11403Surgery

Exc tr-ext b9+marg 2.1-3cm

CPT 11403 covers the surgical removal of a benign (non-cancerous) skin growth or lesion from the trunk, arms, or legs when the lesion measures between 2.1 and 3.0 centimeters in diameter, including margins removed around it.

Showing rates for

National Average

Base Medicare rate

$193.11

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

1.84

PE RVU (NF)

3.85

MP RVU

0.28

Total RVU

5.97

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

NCCI bundling edits

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Billing tips

Measure the excised diameter including margins in the pathology report or operative note, not just the visual lesion size—this determines correct code selection within the 11400-11406 series
Impact: Incorrect size coding can result in $50-150 underpayment or overpayment; using 11402 (1.1-2.0 cm) instead of 11403 loses $26 per procedure based on 2025 Medicare rates
When multiple lesions are excised, code each separately and list in descending RVU order—first lesion at full rate, subsequent at 50% with modifier 51
Impact: Proper sequencing maximizes reimbursement; incorrect ordering can reduce payment by 10-25% on multi-lesion cases
Verify anatomic site matches 11403 coverage (trunk, arms, legs, hands, feet)—face, ears, eyelids, nose, lips, and mucous membranes use different code series (11440-11446)
Impact: Wrong anatomic series results in automatic denial; face/scalp/neck codes reimburse $30-80 higher due to complexity
Document medical necessity clearly—cosmetic removals are patient responsibility; include symptoms like pain, bleeding, catching on clothing, or size changes
Impact: Lack of medical necessity documentation triggers denials; appeals require detailed chart notes and may delay payment 60-90 days
Bill facility vs non-facility based on actual site of service—office-based procedures qualify for non-facility rate ($193.11), while hospital/ASC procedures receive facility rate ($147.82)
Impact: Site of service differential is $45.29 per procedure; incorrect POS code causes automatic rate adjustment and potential audit
For lesions at size boundaries (exactly 2.0 or 3.0 cm), document measurement method and round to nearest 0.1 cm; measurements at 2.05-3.0 cm support 11403

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Frequently asked questions

What is the CPT code 11403 used for?

CPT 11403 is used for surgical excision of a benign skin lesion from the trunk, arms, legs, hands, or feet when the total excised diameter including margins measures between 2.1 and 3.0 centimeters. It includes simple closure and is commonly used for removing lipomas, cysts, moles, and other non-cancerous growths.

How much does Medicare pay for CPT 11403 in 2025?

Medicare pays $193.11 for CPT 11403 when performed in a non-facility setting (office) and $147.82 when performed in a facility setting (hospital outpatient or ASC) based on the 2025 national average rates. Actual payment may vary by geographic locality and payer contract.

What is the difference between CPT 11403 and 11402?

The difference is the size of the excised lesion including margins: CPT 11402 covers 1.1-2.0 cm excised diameter, while 11403 covers 2.1-3.0 cm. Both are for benign lesions on trunk/extremities. Correct measurement of the excised specimen (not just the visible lesion) determines which code to use, with 11403 reimbursing approximately $26 more than 11402.

Can CPT 11403 be billed with an office visit on the same day?

Yes, but only if a significant, separately identifiable E/M service is performed and documented, and modifier 25 is appended to the E/M code. The E/M must address issues beyond the normal pre-procedure assessment, such as initial evaluation leading to the decision for excision or management of unrelated conditions.

What are the Work RVUs for CPT code 11403?

CPT 11403 has 1.84 Work RVUs, 3.85 Practice Expense RVUs (non-facility), 2.45 PE RVUs (facility), and 0.28 Malpractice RVUs, for a total of 5.97 non-facility RVUs in 2025. These values are multiplied by the 2025 conversion factor of 32.3465 to determine Medicare payment.

How do you measure lesion size for CPT 11403 billing?

Measure the excised diameter of the entire specimen including margins, not just the visible lesion. This should be documented in the operative note and confirmed in the pathology gross description. For 11403, the total excised diameter must be 2.1-3.0 cm. Measurement should occur after excision or from the pathology report for accurate coding.

What modifiers are commonly used with CPT 11403?

Common modifiers include 25 (separate E/M service), 59 (distinct procedural service for multiple lesions), 51 (multiple procedures), LT/RT (laterality for extremity lesions), 78 (return to OR during global period), and 79 (unrelated procedure during global period). Modifier selection depends on the specific clinical scenario and payer requirements.