CPT 11424Surgery

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CPT 11424 covers the surgical removal of a benign (non-cancerous) skin lesion or growth from the head, face, neck, hands, feet, or genitals when the lesion measures between 3.1 and 4.0 centimeters in diameter, including the margin (extra tissue removed around it).

Showing rates for

National Average

Base Medicare rate

$232.89

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

2.48

PE RVU (NF)

4.33

MP RVU

0.39

Total RVU

7.2

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

NCCI bundling edits

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Billing tips

Measure the lesion plus margins after excision, not before. The excised diameter (pathology specimen size) determines the correct code, not the clinical pre-excision measurement.
Impact: Incorrect measurement is the #1 cause of upcoding/downcoding audits. Difference between 11423 ($188.17) and 11424 ($232.89) is $44.72 per procedure.
Document the exact anatomic location (face, scalp, neck, hand, foot, genitalia) in operative note. Generic terms like 'skin' will result in downcoding to lower-paying body area codes (11403 pays only $167.89).
Impact: Location documentation error can result in $65 loss per claim when downcoded from 11424 to 11403.
When multiple lesions are excised, bill each excision separately ranked by size (largest first). Apply modifier 51 or list in descending RVU order per payer policy.
Impact: Proper sequencing maximizes reimbursement. First lesion: $232.89, second lesion with modifier 51: approximately $116.45 (50% reduction).
Verify pathology confirms benign diagnosis. If malignancy is found, you may need to submit corrected claim using malignant excision codes (11644) which reimburse higher ($312.24 for same size).
Impact: Malignant excision codes pay $79.35 more than benign codes for same size/location. File corrected claim within timely filing limits (typically 1 year).
For Medicare, this code has a 10-day global period. Do not separately bill for routine postoperative visits within 10 days unless complications arise requiring return to OR (use modifier 78).
Impact: Inappropriate billing of post-op visits results in denials and potential audit flags. Global period reimbursement is already included in the $232.89 payment.

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Frequently asked questions

What is the Medicare reimbursement for CPT 11424 in 2025?

The 2025 Medicare national average payment for CPT 11424 is $232.89 in non-facility settings (office) and $178.88 in facility settings (hospital outpatient or ASC). Actual payments vary by geographic locality and are adjusted by the Medicare Geographic Practice Cost Index (GPCI).

What size lesion qualifies for CPT code 11424?

CPT 11424 is used for excision of benign lesions measuring 3.1 to 4.0 centimeters in excised diameter, including margins. The measurement should be taken from the actual excised specimen, not the pre-excision clinical measurement. Lesions 3.0 cm or smaller use 11423, while those over 4.0 cm use 11426.

Can I bill CPT 11424 for lesions on the trunk or extremities?

No, CPT 11424 is specifically for lesions on the head, face, neck, scalp, hands, feet, or genitalia. For benign lesion excisions of the same size (3.1-4.0 cm) on the trunk, arms, or legs, use CPT 11404 instead, which has different reimbursement rates.

How do I bill for multiple benign lesion excisions on the same day?

Bill each excision separately using the appropriate code for each lesion's size and location. List the largest or highest-RVU procedure first, then apply modifier 51 to subsequent procedures (or list in descending order per payer preference). The second and additional procedures typically receive 50% payment reduction under multiple procedure rules.

What is the difference between CPT 11424 and 11644?

CPT 11424 is for benign lesion excision (3.1-4.0 cm) from head/face/neck/hands/feet/genitalia, while 11644 is for malignant lesion excision of the same size from the same locations. Code selection depends on pathology diagnosis. If initial pathology shows malignancy, submit a corrected claim with 11644, which reimburses at $312.24 non-facility versus $232.89 for benign.

Does CPT 11424 include closure of the excision site?

Yes, CPT 11424 includes simple (one-layer) closure. Do not separately bill for simple closure. However, if intermediate closure (layered closure) or complex closure (extensive undermining, stents, retention sutures) is required, you may separately bill closure codes 12031-12057 or 13100-13153 depending on location and size.

What documentation is needed to support medical necessity for CPT 11424?

Document clinical indications such as lesion symptoms (pain, bleeding, itching), functional impairment, recurrent trauma/irritation, diagnostic uncertainty requiring pathologic confirmation, or patient risk factors. Include lesion characteristics, growth history, and why observation is not appropriate. Photographs and patient-reported symptoms strengthen medical necessity claims when cosmetic denials occur.