Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less

CPT 11420 is the billing code for "Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less". For excision of benign lesions 0.5 cm or less on scalp, neck, hands, feet, or genitalia where anatomic complexity is higher

Medicare pays approximately $122.92 for CPT 11420 (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 11420 has a total RVU of 4.25, broken down as: Work RVU 1.89, Practice Expense RVU 2.17, and Malpractice RVU 0.19. RVUs (Relative Value Units) determine Medicare reimbursement rates.

The most common denial reason for CPT 11420 is "Lesion location wrong for 11420 - should use trunk/extremities code 11400". 11420 (excision benign lesion ≤0.5cm scalp/neck/hands/feet/genitalia) for specific anatomic locations only. Same size lesion on trunk/arms/legs = 11400 (different code, different reimbursement). Denied when location documented doesn't match 11420 locations. Anatomic location determines code family - size determines specific code within family. Common causes include: Lesion on forearm billed as 11420 - should be 11400 (trunk/extremities); Neck vs chest confusion - neck = 11420, chest = 11400. Appeal success rate is approximately 10-30%.

Key documentation requirements for CPT 11420 include: Precise anatomic location; Lesion diameter with margins; Excision technique given anatomic location; Closure method appropriate for location. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 11420: Local anesthesia included. Simple closure bundled Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 11420 include: 51 (Multiple lesions excised), 59 (Distinct procedural service), 78 (Related procedure during postop). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

The typical time requirement for CPT 11420 is 20-25 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.