CPT 11471Surgery

Exc skn h/p/p/u complex

CPT 11471 covers the surgical removal of complex skin lesions on the hands, feet, neck, or genitals. These excisions require more extensive work due to location complexity, lesion characteristics, or closure difficulty.

Showing rates for

National Average

Base Medicare rate

$526.60

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

4.89

PE RVU (NF)

10.47

MP RVU

0.92

Total RVU

16.28

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

NCCI bundling edits

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Billing tips

Document specific complexity factors justifying 11471 vs simple excision codes (11420-11426). Include anatomic challenges, closure technique (layered, undermining extent), or patient factors.
Impact: Difference between 11471 ($526.60) and simple excision codes ($150-$300) represents $200-$370 per procedure in proper reimbursement
Bill non-facility rate ($526.60) when performed in office-based setting; facility rate ($345.78) applies only in hospital/ASC where facility bills separately for overhead
Impact: Ensures proper reimbursement differential of $180.82 per procedure based on practice setting
When multiple lesions excised, sequence codes by RVU value (bill highest RVU first without modifier 51, then append 51 to subsequent codes) to maximize reimbursement
Impact: Proper sequencing prevents losing 50% reduction on highest-paying procedure; can save $150-$250 per session
Submit pathology report with claim or have available for audit; many payers require histopathologic confirmation to support medical necessity of excision
Impact: Reduces denial rate by 30-40% and accelerates clean claim payment; prevents medical necessity denials
For lesions near size threshold between 11471 and other excision codes in same family, document excised diameter plus margins in operative note, not just pathology specimen size
Impact: Pathology specimens shrink 10-30% in formalin; operative measurement supports code selection and prevents downcoding
Use specific anatomic documentation (e.g., 'dorsal hand overlying third metacarpal' rather than just 'hand') to support complexity designation and prevent payer downcoding

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 11471 in 2025?

The 2025 Medicare national average reimbursement for CPT 11471 is $526.60 for non-facility settings and $345.78 for facility settings. Non-facility rates apply when performed in physician offices with overhead costs included. Facility rates apply in hospital outpatient departments or ASCs where the facility bills separately. Actual reimbursement varies by geographic location based on locality-specific adjustments to the national rate.

What makes a skin excision 'complex' for billing CPT 11471?

Complexity for 11471 is defined by anatomic location (hands, feet, neck, scalp, genitalia) where excision and closure present technical challenges. Additional complexity factors include: required layered closure, extensive undermining for tension-free closure, tissue rearrangement, involvement of free margins requiring complex repair, or anatomic constraints limiting closure options. Simple linear closure in straightforward anatomic sites would not qualify as complex.

Can CPT 11471 be billed with an E/M service on the same day?

Yes, but only when the E/M service is separately identifiable from the excision procedure. Append modifier 25 to the E/M code. The E/M must address separate problems beyond the excision, or document that the decision for surgery was made during that encounter with appropriate medical decision-making. Documentation must clearly separate the E/M components from the pre-operative assessment included in the surgical code.

How many RVUs is CPT code 11471 worth in 2025?

CPT 11471 has a total of 16.28 RVUs in 2025, consisting of 4.89 work RVUs, 10.47 non-facility practice expense RVUs (4.88 facility PE RVUs), and 0.92 malpractice RVUs. These RVUs multiplied by the 2025 conversion factor of $32.3465 determine the Medicare payment rates.

What documentation is required to justify billing 11471 instead of a simple excision code?

Documentation must establish complexity through: specific anatomic location within complex sites (hands, feet, neck, genitalia), excision size with margins, closure technique details (layered closure, undermining extent in cm, tissue rearrangement), anatomic challenges encountered, and medical necessity. Operative notes should describe why the location or closure required work beyond simple excision. Pathology correlation and post-operative diagnosis are also required elements.

What are common CPT codes billed with 11471?

Common pairings include pathology codes (88305 for tissue examination), repair codes when intermediate/complex repair is required beyond excision closure (12031-13133), and same-day E/M with modifier 25. Multiple excisions are often billed together (11471 with modifier 51 for additional lesions, or other excision codes from 11400-11471 series). Avoid bundling with codes included in the global surgical package.

Does CPT 11471 have a global surgery period?

Yes, CPT 11471 has a 10-day global surgery period. This includes the procedure day, normal post-operative care, and follow-up visits within 10 days. Complications or additional procedures during this period require modifiers (78 for related return to OR, 79 for unrelated procedures). E/M services for problems unrelated to the excision can be billed with modifier 24 during the global period.