Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Lesion size exceeds 0.5cm limit - should use higher size-based code
Very Common11400 (excision benign lesion ≤0.5cm trunk/arms/legs) for lesions 0.5cm or smaller. Larger lesions use higher codes: 0.6-1.0cm = 11401, 1.1-2.0cm = 11402, etc. Size must be measured and documented. Denied when documented size >0.5cm but 11400 billed. Measure lesion diameter before excision.
Common Causes
- • Lesion measured 0.7cm - should bill 11401 not 11400
- • Size not documented - payer assumes smallest code and denies upgrade
- • Measured after excision with margins - should measure lesion itself pre-excision
Resolution Strategy
Document lesion size pre-excision: 'Benign nevus right upper arm measuring 0.4cm diameter. Elliptical excision performed with 2mm margins, total excision 0.8cm. Wound closed with 4-0 nylon simple interrupted sutures.' Size for coding = lesion diameter (0.4cm = 11400), not excision with margins (0.8cm). If lesion 0.6-1.0cm, rebill 11401. Cannot appeal without documented lesion size.
Relative Value Units (RVUs)
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Clinical Information
When to Use
For excision of benign skin lesion on trunk, arms, or legs with diameter 0.5 cm or less
Common Scenarios
Documentation Requirements
- Location and size of lesion
- Preoperative diagnosis
- Surgical margins
- Closure technique
- Pathology specimen sent
Coding Guidelines
Common Modifiers
Bundling Rules
- Includes excision with margins
- Includes simple closure
- Complex closure coded separately
- Pathology bundled when performed same session
- Multiple lesions excised coded separately
Exclusions
- 11600 (excision of malignant lesion)
- 11300 (excision of lesion on face)
- 11401 (excision of benign lesion larger than 0.5 cm)
Coding Notes
Clinical scenarios
- Location and size of lesion
- Preoperative diagnosis
- Surgical margins
- Location and size of lesion
- Preoperative diagnosis
- Surgical margins
- Location and size of lesion
- Preoperative diagnosis
- Surgical margins
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Code Details
Medicare Pricing
PFSRVU Breakdown
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Ask a QuestionFrequently Asked Questions
CPT 11400 is the billing code for "Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less". For excision of benign skin lesion on trunk, arms, or legs with diameter 0.5 cm or less
Medicare pays approximately $124.21 for CPT 11400 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
CPT 11400 has a total RVU of 3.65, broken down as: Work RVU 1.50, Practice Expense RVU 2.00, and Malpractice RVU 0.15. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 11400 is "Lesion size exceeds 0.5cm limit - should use higher size-based code". 11400 (excision benign lesion ≤0.5cm trunk/arms/legs) for lesions 0.5cm or smaller. Larger lesions use higher codes: 0.6-1.0cm = 11401, 1.1-2.0cm = 11402, etc. Size must be measured and documented. Denied when documented size >0.5cm but 11400 billed. Measure lesion diameter before excision. Common causes include: Lesion measured 0.7cm - should bill 11401 not 11400; Size not documented - payer assumes smallest code and denies upgrade. Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 11400 include: Location and size of lesion; Preoperative diagnosis; Surgical margins; Closure technique. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 11400: Includes excision with margins. Includes simple closure Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 11400 include: 51 (Multiple procedures performed same session), 59 (Distinct procedural service if performed separately), LT (Left side procedure). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 11400 is 10-20 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.