CPT 11406Surgery

Exc tr-ext b9+marg >4.0 cm

CPT 11406 covers the surgical removal of a benign (non-cancerous) skin growth or lesion on the trunk, arms, legs, hands, or feet when the removed area is larger than 4.0 centimeters (about 1.6 inches). The procedure includes closing the wound with stitches.

Showing rates for

National Average

Base Medicare rate

$311.82

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

3.52

PE RVU (NF)

5.48

MP RVU

0.64

Total RVU

9.64

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, not just the visible lesion. Documentation must clearly state 'excised diameter >4.0 cm' to justify 11406 over 11404.
Impact: Difference between 11404 and 11406 reimbursement is approximately $60-80. Inadequate size documentation is the #1 cause of downcoding to lower-paying codes.
Verify anatomical location qualifies for 11400 series. Face, ears, eyelids, nose, lips, and mucous membranes require 11440 series codes, which have different fee schedules.
Impact: Using wrong anatomical series results in automatic denial or incorrect payment. 11446 (face, >4.0cm) reimburses at $436.72, significantly higher than 11406.
When performing multiple excisions, apply modifier 51 to lower-valued procedures or consider billing multiple units with appropriate modifiers. Rank procedures by RVU value.
Impact: Proper sequencing maximizes reimbursement. Billing 11406 first (highest RVU 9.64) then smaller excisions with modifier 51 can preserve $100+ compared to incorrect sequencing.
Document whether procedure was performed in facility or non-facility setting. Bill using appropriate place of service code (11 for office, 22 for outpatient hospital, 24 for ASC).
Impact: Non-facility setting pays $311.82 vs facility $244.22, a difference of $67.60. Incorrect POS code will trigger auto-adjustment to lower rate.
Include pathology report confirming benign nature in documentation. If lesion is later found to be malignant, consider whether re-excision would be separately billable with modifier 58.
Impact: Malignant findings may justify additional procedures during global period. Proper documentation supports medical necessity for any subsequent procedures.

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Applicable modifiers

Mod 51

When to use: Multiple procedures performed during the same operative session. Apply to the second and subsequent excisions when billing multiple lesion removals.

Reimbursement impact: Second procedure typically reimbursed at 50% of allowed amount; subsequent procedures may be reduced further. Can reduce payment by $155.91 or more per additional procedure.

Mod 59

When to use: Distinct procedural service on a separate lesion or different anatomical site when billing multiple excisions that might otherwise appear bundled. Use when medical necessity documentation supports separate lesions.

Reimbursement impact: Prevents automatic bundling and denial; preserves full reimbursement for legitimately separate procedures. Can protect $311.82 in revenue that would otherwise be denied.

Mod 78

When to use: Return to the operating room for a related procedure during the postoperative period (e.g., dehiscence repair, hematoma evacuation). Must be related to the original excision.

Reimbursement impact: Allows payment during global period but typically at reduced rate. Payment generally reduced to intraoperative portion only.

Mod 79

When to use: Unrelated procedure during the postoperative period. Use when performing a new, unrelated excision within the 10-day global period of the original 11406.

Reimbursement impact: Allows full reimbursement for the new procedure despite being within the global period of the first. Preserves full $311.82 payment.

Mod LT/RT

When to use: When excising lesions on left or right extremities and billing multiple units. Required by some payers to distinguish bilateral or multiple sites.

Reimbursement impact: Prevents denials for duplicate billing; clarifies anatomical location. Essential for clean claims processing.

Mod 58

When to use: Staged or related procedure during postoperative period. Use if performing planned re-excision for margins or staged removal of large lesion.

Reimbursement impact: Allows payment during global period for planned staged procedures. Typically reimbursed at full rate if properly documented as staged.

Frequently asked questions

What is the Medicare reimbursement rate for CPT code 11406 in 2025?

The 2025 Medicare national average reimbursement for CPT 11406 is $311.82 for non-facility settings (office-based) and $244.22 for facility settings (hospital outpatient or ASC). Actual rates may vary by geographic location based on local Medicare Administrative Contractor (MAC) adjustments.

How do I measure lesion size for CPT 11406 billing?

Measure the excised diameter, which includes the lesion plus the margins removed, not just the visible lesion itself. The total excised diameter must exceed 4.0 cm to qualify for 11406. Document the measurement in the operative note, ideally noting both the lesion size and the margin width. For example: 'lesion measuring 3.2 cm with 0.5 cm margins, total excised diameter 4.2 cm.'

What is the difference between CPT 11406 and 11404?

Both codes cover benign lesion excision from the same anatomical areas (trunk, arms, legs, hands, feet), but differ by size. CPT 11404 covers excised diameters of 3.1 to 4.0 cm, while 11406 covers excised diameters greater than 4.0 cm. The size difference results in different reimbursement rates, with 11406 paying approximately $60-80 more than 11404.

Can I bill an E/M code with CPT 11406 on the same day?

Generally, the decision for surgery is included in the surgical procedure and cannot be separately billed. However, if you perform a significant, separately identifiable evaluation and management service beyond the decision for surgery (such as evaluating an unrelated problem), you may bill an E/M code with modifier 25 attached. Documentation must clearly show the separate nature of the E/M service.

How many units of CPT 11406 can I bill for multiple large lesions?

CPT 11406 is billed per lesion, but you should apply modifier 51 (multiple procedures) to the second and subsequent procedures. Some payers prefer separate line items with modifier 51, while others accept multiple units. The second and subsequent procedures are typically reimbursed at 50% or less of the primary procedure rate. Use modifiers 59, LT, or RT as appropriate to indicate distinct lesions.

What anatomical locations are covered by CPT 11406?

CPT 11406 covers benign lesion excisions from the trunk, arms, legs, hands, feet, neck, scalp, and genitalia. It does NOT cover the face, ears, eyelids, nose, lips, or mucous membranes—those locations require codes from the 11440-11446 series. Proper anatomical location documentation is essential for correct code selection.

What is the global period for CPT 11406?

CPT 11406 has a 10-day global period. This means routine postoperative care for 10 days following the procedure is included in the reimbursement and cannot be separately billed. If you perform an unrelated procedure during this 10-day window, append modifier 79. If you return to the OR for a complication related to the original procedure, use modifier 78.