Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.6 cm to 1.0 cm
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Lesion size outside 0.6-1.0cm range for this code
Common11401 specifically for 0.6-1.0cm lesions trunk/arms/legs. Smaller = 11400 (≤0.5cm), larger = 11402 (1.1-2.0cm). Must document lesion diameter before excision, not specimen size with margins. Size determines code - strict enforcement.
Common Causes
- • Lesion 0.5cm - should be 11400 not 11401
- • Lesion 1.2cm - should be 11402 not 11401
- • Specimen with margins measured 1.0cm but lesion only 0.7cm - code by lesion size
Resolution Strategy
Document clinical lesion size: 'Seborrheic keratosis left forearm, 0.8cm diameter clinically. Shave excision performed, specimen sent to pathology.' Code based on clinical measurement (0.8cm = 11401), not pathology specimen size which includes margins. If lesion <0.6cm or >1.0cm, rebill with size-appropriate code. Cannot appeal if documented size clearly outside 0.6-1.0cm range.
Relative Value Units (RVUs)
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Clinical Information
When to Use
For excision of benign skin lesions 0.6-1.0 cm in diameter including margins on trunk, arms, or legs
Common Scenarios
Documentation Requirements
- Lesion location and description
- Diameter including margins measured
- Excision technique
- Closure method and materials
- Specimen sent to pathology
Coding Guidelines
Common Modifiers
Bundling Rules
- Local anesthesia bundled
- Simple closure included in code
- Diameter includes narrowest margin
Exclusions
- Skin tags use 11200-11201
- Malignant lesions require 11600 series codes
- Lesions over 1.0 cm use higher codes
Coding Notes
Clinical scenarios
- Lesion location and description
- Diameter including margins measured
- Excision technique
- Lesion location and description
- Diameter including margins measured
- Excision technique
- Lesion location and description
- Diameter including margins measured
- Excision technique
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Code Details
Medicare Pricing
PFSRVU Breakdown
OPPS Details
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Ask a QuestionFrequently Asked Questions
CPT 11401 is the billing code for "Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.6 cm to 1.0 cm". For excision of benign skin lesions 0.6-1.0 cm in diameter including margins on trunk, arms, or legs
Medicare pays approximately $151.06 for CPT 11401 (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 11401 has a total RVU of 4.78, broken down as: Work RVU 2.14, Practice Expense RVU 2.43, and Malpractice RVU 0.21. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 11401 is "Lesion size outside 0.6-1.0cm range for this code". 11401 specifically for 0.6-1.0cm lesions trunk/arms/legs. Smaller = 11400 (≤0.5cm), larger = 11402 (1.1-2.0cm). Must document lesion diameter before excision, not specimen size with margins. Size determines code - strict enforcement. Common causes include: Lesion 0.5cm - should be 11400 not 11401; Lesion 1.2cm - should be 11402 not 11401. Appeal success rate is approximately 10-30%.
Key documentation requirements for CPT 11401 include: Lesion location and description; Diameter including margins measured; Excision technique; Closure method and materials. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 11401: Local anesthesia bundled. Simple closure included in code Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 11401 include: 51 (Multiple lesions same session), 59 (Distinct procedural service), 76 (Repeat procedure by same physician). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 11401 is 20-25 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.