CPT 11601Surgery

Exc tr-ext mal+marg 0.6-1 cm

CPT 11601 is for surgically removing a cancerous skin growth (0.6 to 1.0 cm in size) from the trunk, arms, or legs, including margins to ensure complete removal. This is more extensive than a simple skin tag removal and involves excision of malignant tissue.

Showing rates for

National Average

Base Medicare rate

$221.57

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

2.07

PE RVU (NF)

4.53

MP RVU

0.25

Total RVU

6.85

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

NCCI bundling edits

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Billing tips

Always measure and document the lesion diameter PLUS margins in the operative note, not just the pathology specimen size. Measure pre-excision at greatest clinical diameter.
Impact: Prevents downcoding from $221.57 (11601) to $153.20 (11600); proper documentation protects $68.37 per claim
Bill facility code when performed in ASC or hospital outpatient setting to reflect lower overhead costs and avoid claim rejections
Impact: Non-facility rate of $221.57 vs facility rate of $144.91; incorrect place of service coding triggers $76.66 recoupment
Verify pathology confirms malignancy before final claim submission; keep biopsy reports readily accessible for audit requests
Impact: Billing malignant excision codes without pathology proof results in 100% denial and potential prepayment review; can lose entire $221.57
When excising multiple lesions in the same size category, bill the first excision at full rate and append modifier 51 to subsequent excisions
Impact: First lesion pays $221.57, second pays approximately $110.79 (50%); failure to use modifier 51 triggers automatic denials of secondary procedures
Document anatomical location precisely (trunk vs extremity vs face) as this determines code family selection and reimbursement rate
Impact: Face/scalp excisions (116xx series) reimburse higher than trunk/extremity (116xx series); misclassification can result in $50-100 difference per procedure
For lesions measuring exactly at size break points (e.g., exactly 1.0 cm), document margins separately and use total excised diameter to select code
Moving from 11601 (up to 1.0 cm) to 11602 (1.1-2.0 cm) increases reimbursement from $221.57 to $289.44, a gain of $67.87

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 11601 in 2025?

The 2025 Medicare national average reimbursement for CPT 11601 is $221.57 for non-facility settings and $144.91 for facility settings (ASC/hospital outpatient). Actual payment may vary by geographic locality based on the GPCI adjustment factors for your region.

How do you measure lesion size for CPT 11601 billing?

Measure the greatest clinical diameter of the lesion plus the narrowest margin required for complete excision BEFORE removing the lesion. For 11601, the total excised diameter must be 0.6 cm up to and including 1.0 cm. Document this measurement in the operative note, not just the pathology specimen size which may shrink.

What is the difference between CPT 11601 and 11401?

CPT 11601 is for excision of malignant lesions while 11401 is for benign lesions of the same size range (0.6-1.0 cm) on trunk/arms/legs. The malignant code 11601 reimburses at $221.57 compared to approximately $153 for benign code 11401. Pathology confirmation of malignancy is required for 11601.

Can you bill CPT 11601 with an E/M code on the same day?

Yes, but only if a significant, separately identifiable evaluation and management service is performed beyond the decision for surgery. You must append modifier 25 to the E/M code and document the separate nature of the service. The E/M must address issues beyond the excision procedure itself.

What modifiers are required when billing multiple excisions with CPT 11601?

When performing multiple excisions in the same session, bill the first excision at full rate without a modifier and append modifier 51 to all subsequent excisions. Use modifier 59 or XS when excisions are in different anatomical sites or separate lesions to prevent inappropriate bundling. Use LT/RT for laterality on extremities.

Does CPT 11601 include the pathology examination?

No, CPT 11601 only covers the surgical excision and simple closure. Pathology examination is billed separately by the pathologist using code 88305 (level IV surgical pathology) for skin excisions. The physician performing the excision cannot bill for the pathology interpretation.

What documentation is needed to support medical necessity for CPT 11601?

Required documentation includes pathology confirmation of malignancy (either prior biopsy or final pathology), pre-excision lesion measurements, specific anatomical location, clinical indication for excision, and description of the procedure performed. For audits, maintain dermoscopy images, clinical photos, or prior biopsy reports showing malignant diagnosis.