The short version
- Benign lesion excision (CPT 11400-11446) is coded by the excised diameter, the lesion diameter plus the narrowest margins, measured before excision.
- Coding from the pathology-report size systematically under-codes, because tissue shrinks in formalin and the specimen reads smaller than what you removed.
- Simple closure is bundled into the excision; intermediate (12031-12057) and complex (13100-13160) repair are separately reportable when documented.
- A benign excision needs a documented medical reason, symptomatic or clinically concerning, because ‘the patient dislikes it’ is cosmetic and non-covered.
- → Benign excision (CPT 11400-11446) is coded by excised diameter, not pathology size
- → Three body regions, six size tiers, one measurement rule
- → Simple closure is included; intermediate and complex repair are not
- → A benign excision needs a documented medical reason
- → What the benign excision note needs before you bill CPT 11400
Benign excision (CPT 11400-11446) is coded by excised diameter, not pathology size
The single most expensive mistake in benign excision coding is measuring the wrong thing.
Code selection is driven by the excised diameter: the greatest diameter of the lesion plus twice the narrowest clinical margin needed to remove it. A 1.0 cm lesion with 0.5 cm margins on each side is a 2.0 cm excised diameter, not 1.0. That measurement has to be recorded in the operative note before excision, because formalin shrinks tissue and the pathology-report specimen size comes back smaller than what you actually cut.
Code from the path report and you under-code every time, quietly, on every excision. The AAFP guidance on lesion-removal coding lays out the same formula. This is the coding cousin of the per-lesion trap we covered in 17110 and benign lesion destruction: the code hinges on a measurement rule that’s easy to get subtly wrong.
Three body regions, six size tiers, one measurement rule
The 114xx series is a grid: three anatomic families, each with six excised-diameter tiers.
The 11400s cover the trunk, arms, and legs. The 11420s cover the scalp, neck, hands, feet, and genitalia. The 11440s cover the face, ears, eyelids, nose, lips, and mucous membrane, the areas where excision is most delicate and reimburses highest. Within each family the tiers run 0.5 cm or less, 0.6 to 1.0, 1.1 to 2.0, 2.1 to 3.0, 3.1 to 4.0, and over 4.0 cm. One quirk to know: the face series skips a number, jumping from 11444 to 11446, because 11445 doesn’t exist.
Excision is per lesion. Each lesion removed gets its own code, with modifier 59 or a more specific X modifier to distinguish separate sites when the edits would otherwise bundle them. Pick the family by location, the tier by excised diameter, and the grid does the rest.
Simple closure is included; intermediate and complex repair are not
Closure is where excision claims either capture legitimate work or invite a takeback.
Simple, non-layered closure is bundled into the excision code and never billed separately. When the wound requires a layered closure, intermediate repair (12031-12057) or complex repair (13100-13160) is separately reportable, but only when it’s actually performed and documented as such. The distinction is real work: a single-layer stitch is simple and included; a layered repair with deep sutures is intermediate and payable.
Two things make this the highest-yield line on the claim. First, the money: a benign excision runs roughly $128 to $398 by region and size, but an intermediate repair (12031) pays about $260 and a complex repair (13100) about $338 — the closure routinely out-earns the excision it follows, so leaving it off is the expensive version of this mistake. Second, the mechanics: NCCI pairs intermediate and complex closure with the excision as a column-one/column-two edit, so even though the repair is separately reportable, the closure line needs the appropriate modifier (59, or a specific X{EPSU} modifier) and a note that documents the layered repair — bill it bare and it denies as bundled. These are 2026 Medicare national averages; your locality and every commercial contract differ, and NCCI edits change quarterly, so check your own payer grid.
Bill an intermediate or complex repair when the note describes a simple closure and you’ve created an audit target. On the smallest excisions, the 0.5 cm-or-less codes, Medicare’s edits bundle repair anyway, and many payers won’t pay layered closure on a benign excision at all, so read the policy before you assume the repair line pays. (Payer policy links by code: the Medical Necessity tool on Billing IQ.)
A benign excision needs a documented medical reason
A benign lesion is not automatically a covered excision.
Coverage requires a documented medical reason: the lesion is symptomatic, bleeding, painful, recurrently irritated or infected, functionally interfering, or clinically concerning enough to warrant removal. The diagnosis codes carry that story, benign neoplasms in the D22 and D23 families, cysts in the L72 family, but the note has to establish why removal was necessary. Per the CMS article on removal of benign skin lesions (A57482), a lesion removed only because the patient dislikes its appearance is cosmetic and non-covered.
“Patient requests removal” is not a covered indication. “Recurrent bleeding and irritation from friction at the belt line” is. The diagnosis and the reason have to travel together, or a legitimately benign excision reads as cosmetic. The AAD Coding Resource Center is the specialty reference for keeping that documentation clean.
What the benign excision note needs before you bill CPT 11400
Two failures dominate benign excision claims: coding from the wrong measurement, and billing a lesion with no covered reason. Both are fixed in the note.
- Record the excised diameter before you cut. Lesion plus twice the narrowest margin, in the operative note, so the code reflects what you removed rather than what formalin shrank.
- Match the code to location and tier. The right family for the site, the right size band for the diameter, and a separate code per lesion.
- Document the closure honestly. Simple stays bundled; bill intermediate or complex only when the layered repair is performed and described.
- Give the excision a covered reason. Symptomatic or clinically concerning, in the note, not “patient dislikes it.”
None of this is exotic dermatology. It’s measurement discipline and documentation, the difference between a benign excision that pays what it should and one that under-codes or denies, and the kind of pattern our medical billing team catches across a whole schedule. The smaller lesion-removal methods follow their own rules, which we take up in shave removal coding.
Frequently asked questions
How is a benign lesion excision code selected?
The code is chosen by the excised diameter, which is the greatest diameter of the lesion plus twice the narrowest clinical margin, then matched to the body region. A 1.0 cm lesion with 0.5 cm margins is a 2.0 cm excised diameter.
Should benign excision be coded from the pathology report size?
No. The pathology specimen shrinks in formalin and reads smaller than what was removed, so coding from it systematically under-codes. The excised diameter must be measured and recorded before excision, in the operative note.
Is wound closure billed separately from a benign excision?
Simple, non-layered closure is bundled into the excision code and not billed separately. Intermediate repair (12031-12057) and complex repair (13100-13160) are separately reportable when a layered closure is performed and documented, though the smallest excisions bundle repair under Medicare edits.
What are the CPT codes for benign lesion excision?
CPT 11400-11406 covers the trunk, arms, and legs; 11420-11426 covers the scalp, neck, hands, feet, and genitalia; and 11440-11446 covers the face, ears, eyelids, nose, and lips. Each family has six excised-diameter tiers, and 11445 does not exist.
Is a benign lesion excision covered by insurance?
Only with a documented medical reason: the lesion is symptomatic, recurrently irritated or infected, functionally interfering, or clinically concerning. Removal solely because the patient dislikes the appearance is cosmetic and non-covered per CMS guidance.
What ICD-10 codes support a benign excision?
Benign neoplasms in the D22 and D23 families and cysts in the L72 family are typical, but the note must establish why removal was medically necessary. The diagnosis alone, without a documented symptom or clinical concern, can read as cosmetic.
Can you bill wound closure separately with a benign excision?
Simple, single-layer closure is bundled into the excision code and not billed separately. Intermediate repair (12031-12057) and complex repair (13100-13160) are separately reportable when actually performed and documented — but NCCI pairs them with the excision, so the closure line needs the appropriate modifier (59 or an X{EPSU} modifier). The closure often pays more than the excision itself, so capturing it correctly matters.
This article explains how these codes tend to get paid — it is not coding, billing, or legal advice. Some of the codes here are bundled into the main procedure, or fall into grey areas that vary by payer. Before billing anything in a grey area, confirm it with your own coding and compliance team and the current guidance from the American Academy of Dermatology (AAD), Medicare (CMS), and AMA CPT. When in doubt, don’t bill it.
