CPT 11404Surgery

Exc tr-ext b9+marg 3.1-4 cm

CPT 11404 is used when a doctor surgically removes a non-cancerous skin growth or lesion that measures between 3.1 and 4.0 centimeters (about 1.2 to 1.6 inches) from the trunk, arms, legs, hands, feet, or scalp, including a margin of normal tissue around it.

Showing rates for

National Average

Base Medicare rate

$218.99

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

2.11

PE RVU (NF)

4.3

MP RVU

0.36

Total RVU

6.77

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Measure the lesion plus margins after excision, not the pre-excision clinical diameter alone. The excised diameter (lesion + margins) determines code selection.
Impact: Incorrect measurement is the #1 audit trigger; accurate documentation prevents downcoding from 11404 ($218.99) to 11403 ($167.85), a $51.14 loss per procedure
Document the specific body site (trunk vs. extremity vs. scalp) in the operative note. While 11404 covers multiple sites, some payers require anatomic specificity for medical necessity.
Impact: Missing site documentation accounts for 18-22% of denials; clear documentation prevents $218.99 payment delays
Bill in non-facility settings when performing in-office to capture the higher rate. Ensure your billing system defaults to place of service (POS) 11 for office procedures.
Impact: Non-facility rate is $218.99 vs. facility rate of $162.70, a difference of $56.29 (34.6% higher reimbursement) per procedure
When excising multiple lesions, list the largest/most complex lesion first without modifier 51, then append modifier 51 to subsequent codes in descending RVU order.
Impact: Proper sequencing maximizes reimbursement; incorrect ordering can cost $50-100 when multiple excisions performed in same session
Send pathology reports showing benign findings within 30 days of the procedure for all excisions. Code the pathology separately (88305 for most benign lesions).
Impact: Pathology confirmation supports medical necessity and prevents retrospective denials; 88305 adds approximately $37-62 additional revenue per specimen
For lesions measuring exactly on size break points (e.g., exactly 3.1 cm or 4.0 cm), document precisely and select the code that includes that measurement. 11404 includes 3.1-4.0 cm.

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 11404?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is the Medicare reimbursement rate for CPT 11404 in 2025?

The 2025 Medicare national average payment for CPT 11404 is $218.99 for non-facility settings (office/clinic) and $162.70 for facility settings (hospital outpatient or ASC). These rates are based on the CMS Physician Fee Schedule with a conversion factor of 32.3465 and may vary by geographic locality based on the GPCI adjustment factors.

How do I measure a lesion correctly for billing CPT 11404?

Measure the excised specimen's greatest clinical diameter including margins after removal, not just the visible lesion before excision. For 11404, the total excised diameter must be between 3.1 and 4.0 cm. Document the measurement in the operative note in centimeters with precision (e.g., '3.8 cm lesion with margins excised'). The pathology report gross description should corroborate your measurement.

Can I bill CPT 11404 with an E/M code on the same day?

Yes, but you must append modifier 25 to the E/M code and document a separate, significant, and identifiable evaluation and management service beyond the usual pre-operative assessment for the excision. The E/M documentation must support a distinct problem or decision-making process separate from the decision to perform the excision itself.

What RVU value does CPT 11404 have for 2025?

CPT 11404 has a total RVU of 6.77 for 2025, comprising 2.11 work RVUs, 4.30 non-facility practice expense RVUs (2.56 facility PE RVUs), and 0.36 malpractice RVUs. These values are published in the CMS Medicare Physician Fee Schedule RVU25A file released December 23, 2024.

What diagnosis codes support medical necessity for CPT 11404?

Common supporting ICD-10 codes include D23.x (benign neoplasm of skin by site), L72.x (follicular cysts), D17.x (benign lipomatous neoplasm), L91.8 (other hypertrophic skin disorders), and L98.9 (disorder of skin, unspecified). Documentation must show the lesion causes symptoms, functional impairment, risk of trauma/bleeding, or has concerning features requiring removal beyond cosmetic reasons.

Can CPT 11404 be billed multiple times on the same date of service?

Yes, when multiple separate lesions meeting the 3.1-4.0 cm size criteria are excised during the same session. Bill the first lesion with CPT 11404 at full rate, then add modifier 51 to subsequent 11404 codes. Most payers reimburse the second and additional procedures at 50% of the allowed amount. Always use modifier 59 or anatomic modifiers (LT/RT) when necessary to indicate distinct sites.

What's the difference between CPT 11404 and 11403 for billing purposes?

CPT 11404 is for excised lesions measuring 3.1-4.0 cm including margins, while 11403 covers 2.1-3.0 cm. The 2025 Medicare non-facility reimbursement difference is significant: 11404 pays $218.99 versus 11403 at approximately $167.85, a difference of about $51. Accurate measurement documentation is critical as this is a frequent audit focus and downcoding target.