CPT 11422Surgery

Exc h-f-nk-sp b9+marg 1.1-2

CPT 11422 covers the surgical removal of a benign (non-cancerous) skin growth on the head, face, neck, hands, feet, or genitals when the lesion measures between 1.1 and 2.0 centimeters in diameter, including the margins removed around it.

Showing rates for

National Average

Base Medicare rate

$174.35

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

1.68

PE RVU (NF)

3.5

MP RVU

0.21

Total RVU

5.39

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—this is the dimension that determines code selection. Document the measurement in the operative note before excision.
Impact: Coding 11422 instead of 11421 (0.6-1.0 cm) increases Medicare reimbursement by approximately $30-40; incorrect downcoding to 11421 costs $30+ per claim
Verify anatomic location qualifies for the head-face-neck-hands-feet-genitalia (h-f-nk-sp) designation; trunk/arms/legs use different code series (11401-11406) with lower reimbursement
Impact: CPT 11422 pays $174.35 vs. 11402 (trunk/extremities, same size) pays approximately $145-155; incorrect location coding creates $20-30 loss per procedure
Bill only one code per lesion regardless of closure complexity; layered repairs are included in the excision code for benign lesions and cannot be separately billed
Impact: Attempting to bill separate repair codes (12xxx series) with benign excisions triggers NCCI edits and automatic denials; avoid compliance risk
When billing multiple excisions in one session, list the largest/most complex excision first without modifier 51, then append modifier 51 to subsequent codes in descending RVU order
Impact: Proper sequencing maximizes reimbursement under MPPR; first procedure pays 100% ($174.35), subsequent procedures pay 50% ($87.18 each)
Distinguish benign (114xx series) from malignant (116xx series) based on clinical suspicion at time of excision, not final pathology; recoding based on pathology results is appropriate if malignancy is confirmed
Impact: Malignant excision codes (11642 for same size/location) reimburse at $265+ vs. $174.35 for 11422; update coding when pathology contradicts clinical diagnosis

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 11422 in 2025?

For 2025, Medicare pays $174.35 for CPT 11422 in non-facility settings (physician office) and $134.24 in facility settings (hospital outpatient or ASC) based on the national average. Actual payment may vary by geographic locality based on the GPCI adjustments for your area.

How do you measure lesion size for CPT 11422 billing?

Measure the excised diameter including margins before removal, not just the visible lesion. The total excised specimen must measure 1.1 to 2.0 cm at its widest point. Use a ruler or calipers for precise measurement and document the exact size in the operative note. If the lesion is 0.8 cm but you remove 0.3 cm margins circumferentially, the total excised diameter is 1.4 cm, qualifying for 11422.

Can you bill an E/M code on the same day as CPT 11422?

Yes, but only if you perform a significant, separately identifiable evaluation and management service beyond the decision for surgery. You must append modifier 25 to the E/M code and document what additional evaluation was performed. Simply examining the lesion and deciding to excise it does not qualify for a separate E/M service.

What anatomic locations qualify for CPT 11422 versus 11402?

CPT 11422 is for excisions on the head, face, ears, eyelids, nose, lips, mucous membranes, neck, hands, feet, and genitalia. CPT 11402 covers the same size range (1.1-2.0 cm) but for trunk, arms, and legs. The anatomic designation significantly affects reimbursement, with 11422 paying approximately $20-30 more than 11402.

What modifiers are commonly used with CPT 11422?

Modifier 51 for multiple procedures (second and subsequent excisions), modifier 59/XS for distinct procedural services to bypass NCCI edits, modifier 25 for separate E/M services, and modifiers LT/RT for laterality on paired structures. Modifier 51 reduces payment by 50% on subsequent procedures under Medicare's multiple procedure payment reduction rules.

Can you bill CPT 11422 and a repair code together?

No, repair/closure is included in the benign excision code. CPT guidelines specifically state that simple and intermediate closures are bundled into excision codes 11420-11426. Attempting to separately bill repair codes (12xxx or 13xxx series) with benign excisions will trigger NCCI edits and result in claim denials.

What is the difference between CPT 11422 and 11642?

CPT 11422 is for benign lesion excision while 11642 is for malignant lesion excision, both for the same anatomic areas and size range (1.1-2.0 cm). Code selection is based on clinical suspicion at the time of excision. If pathology later confirms malignancy, you can recode to 11642, which reimburses at approximately $265 compared to $174.35 for 11422—a significant difference of about $90.