CPT 11423Surgery

Exc h-f-nk-sp b9+marg 2.1-3

CPT 11423 covers the surgical removal of a benign (non-cancerous) skin growth between 2.1 and 3.0 centimeters in diameter from the head, face, neck, hands, feet, or genitals, including margins to ensure complete removal.

Showing rates for

National Average

Base Medicare rate

$200.87

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

2.06

PE RVU (NF)

3.87

MP RVU

0.28

Total RVU

6.21

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

NCCI bundling edits

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Billing tips

Measure the lesion diameter at its greatest clinical dimension before excision and document precisely in the operative note. If the lesion measures exactly 2.0 cm, use 11422 instead; if 3.1 cm or greater, use 11424.
Impact: Incorrect size selection costs $32-48 per claim; 11422 pays $168.91 vs 11423 at $200.87 vs 11424 at $248.42
Verify anatomic site qualifies for the H-F-Nk-Sp series (head, face, neck, scalp, hands, feet, genitalia). Lesions on trunk or extremities require 11400-series codes with significantly lower reimbursement.
Impact: Incorrect anatomic series selection results in payment difference of approximately $70-90; 11403 (trunk 2.1-3.0cm) pays only $130.54
When performing multiple excisions, list the largest or most complex excision first without modifier 51, then append modifier 51 to all subsequent excisions to maximize reimbursement under multiple procedure rules.
Impact: Proper sequencing maximizes payment; incorrect ordering can reduce total reimbursement by $50-100 for multiple excision sessions
Document whether the procedure was performed in a facility or non-facility setting accurately on the claim. Non-facility settings reimburse $45.28 more per procedure due to higher practice expense.
Impact: Place of service errors result in $45.28 underpayment or overpayment per claim and may trigger audits
Include pathology documentation confirming benign diagnosis. If pathology reveals malignancy, the excision may need to be recoded to malignant lesion series (11640-11646) with different reimbursement and global periods.
Impact: Failure to recode after malignant pathology results in underpayment of $80-150 and exposes practice to audit risk for incorrect coding

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 11423 in 2025?

Medicare pays $200.87 for CPT 11423 in non-facility settings and $155.59 in facility settings for 2025 based on the national average. The code has a total RVU of 6.21 (Work RVU 2.06, Non-Facility PE RVU 3.87, MP RVU 0.28) multiplied by the 2025 conversion factor of 32.3465.

What size lesion does CPT code 11423 cover?

CPT 11423 covers excision of benign lesions measuring between 2.1 and 3.0 centimeters in diameter at the greatest clinical dimension. Lesions measuring 2.0 cm or less should be coded with 11422, while lesions 3.1 cm or larger should be coded with 11424 or higher.

What body areas are included in CPT 11423?

CPT 11423 applies only to lesions on the head, face, neck, scalp, hands, feet, and genitalia. These are considered cosmetically or functionally sensitive areas. Lesions on the trunk, arms, or legs require different codes from the 11400-11406 series with lower reimbursement rates.

Can I bill CPT 11423 with an office visit on the same day?

Yes, you can bill an E/M visit with CPT 11423 on the same day if the visit involves a separately identifiable evaluation beyond the decision for surgery. You must append modifier 25 to the E/M code and document the separate service clearly, such as evaluation of other conditions or significant history taking beyond the excision procedure itself.

How do I bill multiple excisions with CPT 11423?

When performing multiple excisions, list the largest or most complex excision first at full reimbursement, then append modifier 51 to subsequent excisions. The first 11423 pays $200.87, while additional excisions pay approximately 50% or $100.44 each under Medicare's multiple procedure payment reduction rules. Document each lesion's size and location separately.

Does CPT 11423 include closure of the wound?

CPT 11423 includes simple (single-layer) closure only. If you perform intermediate closure requiring layered suturing or complex closure involving extensive undermining or reconstructive techniques, you should separately bill the appropriate repair code from the 12051-13153 series. Document closure complexity clearly in the operative note to support additional coding.

What is the global period for CPT 11423?

CPT 11423 has a 10-day global period. This means routine postoperative care for 10 days after the procedure is included in the reimbursement and cannot be billed separately. Any unrelated E/M services during this period require modifier 24, and complications requiring return to the operating room require modifier 78.