CPT 11420Surgery

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CPT 11420 covers the surgical removal of a small benign (non-cancerous) skin lesion that is 0.5 centimeters or smaller from the scalp, neck, hands, feet, or genitals, including a margin of healthy tissue around it.

Showing rates for

National Average

Base Medicare rate

$122.92

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

1.03

PE RVU (NF)

2.65

MP RVU

0.12

Total RVU

3.8

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

NCCI bundling edits

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Billing tips

Always measure the lesion diameter before excision and document the excised diameter (lesion plus margins) in the operative note, not just the lesion size alone
Impact: Incorrect measurement documentation is the leading cause of downcoding; difference between 11420 ($122.92) and next size code 11421 ($156.86) is $33.94
Bill based on excised diameter (lesion plus narrowest margin on each side), not pre-excision lesion size
Impact: A 0.3cm lesion with 0.2cm margins should be billed as 11421 (0.7cm excised diameter), resulting in 27% higher reimbursement
Verify anatomical site qualifies for 11420-11426 series; scalp, neck, hands, feet, and genitalia only—trunk/extremity lesions use lower-paying 11400 series
Impact: 11420 pays $122.92 vs comparable trunk lesion code 11400 at $107.79, a difference of $15.13 (14% higher)
When excising multiple lesions, bill each lesion separately with appropriate modifiers (59, RT/LT) and document each lesion's specific location and size
Impact: Proper modifier use prevents bundling; three lesions properly billed can yield $368.76 vs single payment of $122.92
Use non-facility rates ($122.92) when performed in office with your own equipment and supplies; facility rates ($81.19) apply only in hospital/ASC settings
Impact: Office-based procedures yield $41.73 more per procedure (51% higher reimbursement) compared to facility settings
Send pathology report with claim when appealing denials for medical necessity; benign designation should be clinical impression, not pathology-dependent
Reduces denial rate by approximately 30% and supports medical necessity determination for initially uncertain lesions

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Frequently asked questions

What is the Medicare reimbursement for CPT code 11420 in 2025?

The 2025 Medicare national average reimbursement for CPT 11420 is $122.92 for non-facility (office) settings and $81.19 for facility settings (hospital/ASC). Actual payment may vary by geographic locality based on the GPCI adjustment factors for your area.

What body locations qualify for CPT 11420 instead of 11400?

CPT 11420 applies only to lesions on the scalp, neck, hands, feet, and external genitalia. These are considered anatomically complex areas requiring greater surgical skill. Lesions on the trunk, arms, legs, or face use the 11400 series codes which have lower reimbursement rates.

How do I measure lesion size for coding CPT 11420?

Measure the excised diameter, which includes the lesion plus the narrowest margin on each side, not just the lesion itself. For 11420, the total excised diameter must be 0.5 cm or less. If a 0.3cm lesion is removed with 0.2cm margins, the excised diameter is 0.7cm and requires code 11421 instead.

Can I bill an E/M visit and CPT 11420 on the same day?

Yes, but only if a significant, separately identifiable evaluation and management service is performed beyond the usual pre-operative assessment. You must append modifier 25 to the E/M code and document the separate service clearly. A visit solely for procedure consent and site marking does not qualify.

What is the difference between CPT 11420 and 11421?

The only difference is the excised diameter size: 11420 is for lesions 0.5cm or less (pays $122.92), while 11421 is for excised diameters 0.6cm to 1.0cm (pays approximately $156.86). Both codes apply to the same anatomical sites (scalp, neck, hands, feet, genitalia).

How many RVUs is CPT 11420 worth in 2025?

CPT 11420 has a total of 3.8 RVUs in 2025, broken down as: 1.03 work RVUs, 2.65 practice expense RVUs (non-facility), 1.36 PE RVUs (facility), and 0.12 malpractice RVUs. These RVUs multiplied by the 2025 conversion factor of 32.3465 determine the payment amount.

Does CPT 11420 include pathology or closure?

CPT 11420 includes simple (single layer) closure but does not include pathology examination. If you perform intermediate or complex closure, you can bill separate repair codes 12031-13133. Pathology examination (88305 for skin lesions) is separately billable by the pathologist or facility, not the surgeon.