Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; 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 or wrong anatomic location
Common11421 for 0.6-1.0cm lesions scalp/neck/hands/feet/genitalia only. Wrong code if: size outside 0.6-1.0cm range, or location is trunk/extremities (use 11401 instead). Must document both size and specific location matching code requirements.
Common Causes
- • Lesion 0.5cm - should be 11420 not 11421
- • Lesion 1.2cm - should be 11422 not 11421
- • Forearm lesion billed as 11421 - should be 11401 (trunk/extremities location)
Resolution Strategy
Verify size AND location: Must be 0.6-1.0cm diameter AND located on scalp, neck, hands, feet, or genitalia. Document: 'Benign cyst left index finger (hand), 0.8cm diameter, excised and closed primarily.' If size wrong, rebill with correct size code. If location wrong, rebill with correct location series (11401 for trunk/extremities, 11441 for face). Cannot appeal without both size and location matching code requirements.
Relative Value Units (RVUs)
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Clinical Information
When to Use
For excision of benign lesions 0.6-1.0 cm on scalp, neck, hands, feet, or genitalia requiring careful technique due to anatomic location
Common Scenarios
Documentation Requirements
- Detailed anatomic location
- Measured diameter including margins
- Special considerations for closure in area
- Suture technique and materials
- Specimen handling and pathology submission
Coding Guidelines
Common Modifiers
Bundling Rules
- Includes local anesthesia
- Simple closure included
- Hemostasis bundled
Exclusions
- Skin tag removal uses different codes
- Malignant lesions require 11641
- Trunk/extremity lesions use 11401
Coding Notes
Clinical scenarios
- Detailed anatomic location
- Measured diameter including margins
- Special considerations for closure in area
- Detailed anatomic location
- Measured diameter including margins
- Special considerations for closure in area
- Detailed anatomic location
- Measured diameter including margins
- Special considerations for closure in area
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Code Details
Medicare Pricing
PFSRVU Breakdown
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Ask a QuestionFrequently Asked Questions
CPT 11421 is the billing code for "Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.6 cm to 1.0 cm". For excision of benign lesions 0.6-1.0 cm on scalp, neck, hands, feet, or genitalia requiring careful technique due to anatomic location
Medicare pays approximately $154.62 for CPT 11421 (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 11421 has a total RVU of 5.30, broken down as: Work RVU 2.38, Practice Expense RVU 2.69, and Malpractice RVU 0.23. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 11421 is "Lesion size outside 0.6-1.0cm range or wrong anatomic location". 11421 for 0.6-1.0cm lesions scalp/neck/hands/feet/genitalia only. Wrong code if: size outside 0.6-1.0cm range, or location is trunk/extremities (use 11401 instead). Must document both size and specific location matching code requirements. Common causes include: Lesion 0.5cm - should be 11420 not 11421; Lesion 1.2cm - should be 11422 not 11421. Appeal success rate is approximately 10-30%.
Key documentation requirements for CPT 11421 include: Detailed anatomic location; Measured diameter including margins; Special considerations for closure in area; Suture technique and materials. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 11421: Includes local anesthesia. Simple closure included Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 11421 include: 51 (Multiple lesions same session), 59 (Distinct procedural service), 76 (Repeat procedure same physician). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 11421 is 25-30 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.