Exc back les sc < 3 cm

CPT code 21930 covers the surgical removal of a skin lesion (growth, mole, or abnormal tissue) from the back that measures less than 3 centimeters in diameter. This involves cutting through the skin and underlying tissue to completely remove the lesion.

Showing rates for

National Average

Base Medicare rate

$490.70

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

4.94

PE RVU (NF)

9.19

MP RVU

1.04

Total RVU

15.17

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

NCCI bundling edits

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Billing tips

Measure the lesion before excision and document the greatest diameter in the operative note; size determines code selection between 21930 (<3cm), 21931 (3cm+), affecting reimbursement significantly
Impact: Incorrect code selection can result in underpayment or overpayment of $200-400 per procedure
Bill in the non-facility setting when performed in office-based surgical suite to capture the higher rate of $490.70 versus $360.99 facility rate
Impact: Increases reimbursement by $129.71 (26.4% higher) per procedure
When multiple lesions are excised, bill the largest/most complex lesion first without modifier, then apply modifier 51 to subsequent excisions to maximize reimbursement
Impact: Proper sequencing can save $50-150 per additional lesion compared to incorrect modifier application
Document subcutaneous involvement clearly; if lesion is only epidermal/dermal without subcutaneous extension, use integumentary codes (11400-11406) instead to avoid downcoding
Impact: Prevents automatic denial and reprocessing delays averaging 45-60 days
Include pathology report confirmation of lesion type and margins in appeal documentation; many payers require histological confirmation for subcutaneous tumor codes
Impact: Improves appeal success rate from 45% to 85% for initially denied claims
For Medicare patients, verify the procedure meets medical necessity criteria with appropriate diagnosis codes (e.g., D21.x for benign neoplasm, C49.x for malignant) rather than symptom-only codes
Impact: Reduces denial rate by approximately 30% and eliminates pre-authorization delays

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 21930 in 2025?

The 2025 Medicare national average reimbursement for CPT 21930 is $490.70 in the non-facility setting and $360.99 in the facility setting. These rates are based on a conversion factor of 32.3465 and total RVU of 15.17. Actual reimbursement may vary based on geographic locality adjustments.

What is the difference between CPT 21930 and skin excision codes 11400-11406?

CPT 21930 is used for excision of subcutaneous soft tissue tumors on the back that extend below the dermis into subcutaneous fat or deeper layers. Codes 11400-11406 are for excision of benign lesions limited to the skin (epidermis and dermis) without significant subcutaneous involvement. The pathology report should confirm tissue depth to support code selection.

How do I bill for multiple back lesion excisions on the same date?

Bill the largest or most complex lesion first with CPT 21930 without a modifier. For each additional lesion excision, bill 21930 again with modifier 51 appended. The primary procedure receives full reimbursement ($490.70 non-facility), while secondary procedures are typically reduced by 50% to approximately $245.35 each.

What RVU values are assigned to CPT 21930 for 2025?

CPT 21930 has a Work RVU of 4.94, non-facility Practice Expense RVU of 9.19, facility Practice Expense RVU of 5.18, and Malpractice RVU of 1.04, for a total non-facility RVU of 15.17 and facility total of 11.16.

Does CPT 21930 include closure of the surgical wound?

Yes, simple and intermediate closure are included in CPT 21930 and should not be billed separately. Only complex closure (CPT 13100-13102) may be billed in addition to 21930 when the repair meets the specific criteria for complex closure requiring layered closure of one or more deeper layers and subcutaneous tissue in addition to skin.

What diagnosis codes support medical necessity for CPT 21930?

Common supporting diagnosis codes include D21.x (benign neoplasm of connective tissue of trunk), C49.x (malignant neoplasm of connective and soft tissue), D48.1 (neoplasm of uncertain behavior), L72.x (follicular cysts), and L92.x (granulomatous disorders of skin). Symptom codes alone (such as R22.2 for localized swelling) may not meet medical necessity criteria without additional clinical justification.

Can CPT 21930 be billed bilaterally with modifier 50?

Yes, modifier 50 can be appended when excising subcutaneous lesions on both the left and right sides of the back during the same operative session. This typically results in 150% reimbursement of the base rate, or approximately $736.05 in the non-facility setting, though payer policies vary and some may require billing with modifiers LT and RT on separate lines instead.